Healthcare Provider Details

I. General information

NPI: 1558712844
Provider Name (Legal Business Name): JASMINE LATRICE WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EASTOWNE DR
CHAPEL HILL NC
27514-2286
US

IV. Provider business mailing address

4611 BLACK DRUM DR
RALEIGH NC
27616-4101
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4462
  • Fax:
Mailing address:
  • Phone: 919-995-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018641
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: