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General NPI Number Information
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NPI Number | 1215290069
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Entity Type | Individual
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Provider Name | JEFFERY ALLEN WILLIAMS LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 1061 TIERRA DEL REY SUITE 200
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City | CHULA VISTA
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State | CA
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Zip | 91910-7880
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Country | US
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Telephone | 619-498-5454
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Fax | 619-498-5455
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Provider Business Mailing Address
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Address Line | PO BOX 609001
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City | SAN DIEGO
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State | CA
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Zip | 92160-9001
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Country | US
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Telephone | 619-528-4600
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Fax | 619-528-4625
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904007884
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28894
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License Number State | CA
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