Provider Demographics
NPI:1801985809
Name:WILLIAMS, JACQUELINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
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:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-1781
Mailing Address - Country:US
Mailing Address - Phone:949-636-3691
Mailing Address - Fax:800-881-7511
Practice Address - Street 1:10000 N 31ST AVE
Practice Address - Street 2:SUITE C218
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:602-441-2388
Practice Address - Fax:800-881-7511
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS185561041C0700X
AZLCSW-16501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS18556OtherLCSW