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General NPI Number Information
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NPI Number | 1992375927
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Entity Type | Individual
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Provider Name | MARCUS D WILLIAMS JR. LMHC
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Gender | Male
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 220 W BRANDON BLVD STE 203
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City | BRANDON
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State | FL
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Zip | 33511-5100
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Country | US
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Telephone | 813-766-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 8826 DEEP MAPLE DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-8981
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Country | US
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Telephone | 813-766-3545
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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 | 19939
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH21096
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License Number State | FL
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