Provider Demographics
NPI:1801371992
Name:WILLIAMS, CHERYL T
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 CAPITAL CIR SE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-7837
Mailing Address - Country:US
Mailing Address - Phone:850-408-8496
Mailing Address - Fax:
Practice Address - Street 1:4750 CAPITAL CIR SE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-7837
Practice Address - Country:US
Practice Address - Phone:850-408-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral