Healthcare Provider Details

I. General information

NPI: 1013376722
Provider Name (Legal Business Name): J DAWSON WILLIAMS D.MIN., LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
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: 877-775-2230
Mailing address:
  • Phone: 501-837-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1604051
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberP1604051
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1604004
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1604051
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: