Provider Demographics
NPI:1477627651
Name:WILLIAMS, JENNIFER MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1002
Mailing Address - Country:US
Mailing Address - Phone:704-376-7447
Mailing Address - Fax:
Practice Address - Street 1:100 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1002
Practice Address - Country:US
Practice Address - Phone:704-376-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1148301041C0700X
SC129471041C0700X
RIISW026431041C0700X
NCC0120051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIISW02643OtherSTATE OF RHODE ISLAND DEPARTMENT OF HEALTH
MA114830OtherCOMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE
SC12947OtherSTATE OF SOUTH CAROLINA BOARD OF SOCIAL WORK EXAMINERS
1477627651OtherNPI
NCC012005OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD