Healthcare Provider Details

I. General information

NPI: 1609459817
Provider Name (Legal Business Name): WILLIAMS COACHING AND COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 09/10/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 FAIR OAKS DR
JACKSONVILLE AR
72076-4280
US

IV. Provider business mailing address

PO BOX 1084
JACKSONVILLE AR
72078-1084
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-9723
  • Fax:
Mailing address:
  • Phone: 501-837-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: J. DAWSON WILLIAMS,
Title or Position: OWNER
Credential: D.MIN., LPC, LMFT
Phone: 501-837-9723