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General NPI Number Information
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NPI Number | 1851863195
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Entity Type | Individual
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Provider Name | JESSE QUINN WILLIAMS LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 25 CANTERBURY RD
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City | ROCHESTER
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State | NY
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Zip | 14607-3403
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Country | US
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Telephone | 585-478-4696
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Fax |
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Provider Business Mailing Address
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Address Line | 180 LYELL ST
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City | SPENCERPORT
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State | NY
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Zip | 14559-9561
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Country | US
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Telephone | 585-478-4696
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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 | 006581-1
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License Number State | NY
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