Provider Demographics
NPI:1013298488
Name:WILLIAMS HARRISON, VIRGINIA SUE (M ED, EDS)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:SUE
Last Name:WILLIAMS HARRISON
Suffix:
Gender:F
Credentials:M ED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 NW 31ST TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2178
Mailing Address - Country:US
Mailing Address - Phone:352-222-5135
Mailing Address - Fax:
Practice Address - Street 1:3515 NW 31ST TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2178
Practice Address - Country:US
Practice Address - Phone:352-222-5135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health