Provider Demographics
NPI:1851863195
Name:WILLIAMS, JESSE QUINN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:QUINN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LYELL ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-9561
Mailing Address - Country:US
Mailing Address - Phone:585-478-4696
Mailing Address - Fax:
Practice Address - Street 1:25 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3403
Practice Address - Country:US
Practice Address - Phone:585-478-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006581-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health