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General NPI Number Information
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NPI Number | 1851126189
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Entity Type | Individual
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Provider Name | KEESHAWANDA WILLIAMS LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 12443 SAN JOSE BLVD STE 401
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8650
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Country | US
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Telephone | 904-383-7613
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Fax |
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Provider Business Mailing Address
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Address Line | 11618 BRIAN LAKES DR
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City | JACKSONVILLE
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State | FL
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Zip | 32221-2855
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Country | US
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Telephone | 904-651-9896
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH24272
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License Number State | FL
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