Provider Demographics
NPI:1770706111
Name:WILLIAMS, JOCELYN RENEE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490333
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0006
Mailing Address - Country:US
Mailing Address - Phone:314-650-6421
Mailing Address - Fax:636-216-0010
Practice Address - Street 1:2202 SHIN CT
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-6806
Practice Address - Country:US
Practice Address - Phone:314-650-6421
Practice Address - Fax:636-216-0010
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040046921041C0700X
GACSW0058861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1141Medicare PIN