Provider Demographics
NPI:1952946469
Name:WILLIAMS, JERRELLE D (MSW)
Entity Type:Individual
Prefix:MR
First Name:JERRELLE
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 ELDERTON DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6971
Mailing Address - Country:US
Mailing Address - Phone:863-513-2883
Mailing Address - Fax:
Practice Address - Street 1:1467 ELDERTON DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6971
Practice Address - Country:US
Practice Address - Phone:863-513-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health