Healthcare Provider Details

I. General information

NPI: 1891358883
Provider Name (Legal Business Name): PETA-GAYE JANICE WILLIAMS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 INDIAN RIVER BLVD
VERO BEACH FL
32960-5639
US

IV. Provider business mailing address

1640 AYNSLEY WAY
VERO BEACH FL
32966-8001
US

V. Phone/Fax

Practice location:
  • Phone: 772-778-1323
  • Fax:
Mailing address:
  • Phone: 772-380-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: