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General NPI Number Information
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NPI Number | 1306619093
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Entity Type | Individual
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Provider Name | TYKERA JA'RISSE WILLIAMS MSW, LSWAIC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 75067 RAVENWOOD DR
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City | YULEE
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State | FL
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Zip | 32097-1607
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Country | US
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Telephone | 410-463-9857
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Fax |
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Provider Business Mailing Address
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Address Line | 76020 WILLIAM BURGESS BLVD UNIT 5-1098
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City | YULEE
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State | FL
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Zip | 32097-5489
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Country | US
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Telephone | 410-463-9857
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61502287
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License Number State | WA
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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 | SC60970283
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License Number State | WA
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