MEDICARE: JEANINE WILLIAMS LCAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	87900095A	IN

General Provider Information

NPI Number	:	1528893534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE WILLIAMS LCAC

Provider Business Mailing Address
First Line	:	8448 E 100 N
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-8741
Country	:	US
Telephone Number	:	765-491-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	8448 E 100 N
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-8741
Country	:	US
Telephone Number	:	765-491-1952
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	04/03/2026

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