Provider Demographics
NPI:1063142842
Name:WILLIAMS, DANIEL JR
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PINE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7401
Mailing Address - Country:US
Mailing Address - Phone:630-442-4856
Mailing Address - Fax:
Practice Address - Street 1:174 PINE HAVEN DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-7401
Practice Address - Country:US
Practice Address - Phone:630-442-4856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107269104100000X
1490284241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker