MEDICARE: JORDACHE WILLIAMS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	8199	SC

General Provider Information

NPI Number	:	1760976773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDACHE WILLIAMS LPC

Provider Business Mailing Address
First Line	:	PO BOX 36652
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-0510
Country	:	US
Telephone Number	:	803-681-0778
Fax Number	:	803-909-9064

Provider Business Practice Location Address
First Line	:	1030 RIVERWALK PKWY STE 204
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-4265
Country	:	US
Telephone Number	:	803-681-0778
Fax Number	:	803-909-9064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	01/04/2024

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