Healthcare Provider Details

I. General information

NPI: 1275651697
Provider Name (Legal Business Name): JILL A. WILLIAMS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 MAITLAND CENTER COMMONS BLVD STE 212
MAITLAND FL
32751-7270
US

IV. Provider business mailing address

1619 TIOGA TRL
WINTER PARK FL
32789-1345
US

V. Phone/Fax

Practice location:
  • Phone: 800-840-2528
  • Fax:
Mailing address:
  • Phone: 407-644-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: