Provider Demographics
NPI:1881073724
Name:AVERY-WILLIAMS, JENNIFER RENAE (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENAE
Last Name:AVERY-WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 FORUM BLVD
Mailing Address - Street 2:#1109
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905
Mailing Address - Country:US
Mailing Address - Phone:239-373-7999
Mailing Address - Fax:
Practice Address - Street 1:2337 N PARK DR # 1001
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8522
Practice Address - Country:US
Practice Address - Phone:239-373-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health