Healthcare Provider Details

I. General information

NPI: 1659524155
Provider Name (Legal Business Name): JOHN GORDON WILLIAMS III LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 EXECUTIVE CENTER DRIVE
ORLANDO FL
32803
US

IV. Provider business mailing address

1010 EXECUTIVE CENTER DR
ORLANDO FL
32803-3529
US

V. Phone/Fax

Practice location:
  • Phone: 321-281-3840
  • Fax: 321-281-3886
Mailing address:
  • Phone: 321-821-3840
  • Fax: 321-281-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: