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General NPI Number Information
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NPI Number | 1194387316
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Entity Type | Individual
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Provider Name | MR. JASON LEMARR WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 431 E LIVINGSTON AVE
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City | COLUMBUS
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State | OH
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Zip | 43215-5533
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Country | US
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Telephone | 614-487-8758
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 CENTURY CITY W APT 9
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-4411
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Country | US
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Telephone | 614-530-4930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.0029847
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License Number State | OH
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