Healthcare Provider Details

I. General information

NPI: 1235845702
Provider Name (Legal Business Name): JENNIFER D WILLIAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 LAKESIDE COMMONS DR STE 320
MACON GA
31210-5791
US

IV. Provider business mailing address

226 RIDGEBEND DR
CENTERVILLE GA
31028-1604
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-9344
  • Fax:
Mailing address:
  • Phone: 478-225-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003839
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: