Provider Demographics
NPI:1841558988
Name:JACQUELINE L WILLIAMS, PHD, LMFT
Entity Type:Organization
Organization Name:JACQUELINE L WILLIAMS, PHD, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:407-956-5773
Mailing Address - Street 1:1540 INTERNATIONAL PKWY
Mailing Address - Street 2:STE 2000
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4713
Mailing Address - Country:US
Mailing Address - Phone:407-956-5773
Mailing Address - Fax:407-536-5301
Practice Address - Street 1:1540 INTERNATIONAL PKWY
Practice Address - Street 2:STE 2000
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-4713
Practice Address - Country:US
Practice Address - Phone:407-956-5773
Practice Address - Fax:407-536-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty