Healthcare Provider Details

I. General information

NPI: 1184008732
Provider Name (Legal Business Name): BRANDI V. WILLIAMSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SUMTER SQUARE DR W
JACKSONVILLE FL
32218-6125
US

IV. Provider business mailing address

12250 SUMTER SQUARE DR W
JACKSONVILLE FL
32218-6125
US

V. Phone/Fax

Practice location:
  • Phone: 904-521-6416
  • Fax: 904-358-1551
Mailing address:
  • Phone: 904-521-6416
  • Fax: 904-358-1551

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: MRS. ANDRIA MYERS
Title or Position: CLIENT FINANCIAL SERVICES COORD
Credential:
Phone: 904-358-1211