Provider Demographics
NPI:1649541293
Name:WILLIAMS, JACQUELINE STACY-ANN (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:STACY-ANN
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 1:3509 OVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8770
Mailing Address - Country:US
Mailing Address - Phone:540-300-2476
Mailing Address - Fax:
Practice Address - Street 1:3509 OVERVIEW DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBRG
Practice Address - State:VA
Practice Address - Zip Code:22408-8770
Practice Address - Country:US
Practice Address - Phone:540-300-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical