Provider Demographics
NPI:1982372207
Name:WILLIAMS, JEFFREY STJOHN (LMSWCC, CADC,MHRT/C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:STJOHN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMSWCC, CADC,MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EAST RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04410-3401
Mailing Address - Country:US
Mailing Address - Phone:207-356-8264
Mailing Address - Fax:
Practice Address - Street 1:263 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:ME
Practice Address - Zip Code:04427-3023
Practice Address - Country:US
Practice Address - Phone:207-285-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6038101YA0400X
MEMC21011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)