MEDICARE: JESSICA RENEE WILLIAMS

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	101YP2500X	Professional Counselor	2911	WV

General Provider Information

NPI Number	:	1821710930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE WILLIAMS

Provider Business Mailing Address
First Line	:	3000 COOMBS FARM RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1189
Country	:	US
Telephone Number	:	304-241-1097
Fax Number	:	304-872-5415

Provider Business Practice Location Address
First Line	:	3000 COOMBS FARM RD
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-1189
Country	:	US
Telephone Number	:	304-241-1097
Fax Number	:

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

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	03/09/2026

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