Provider Demographics
NPI:1104157569
Name:WILLIAMS, JENNIFER L (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ROBERT SMALLS PKWY STE 2B
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4273
Mailing Address - Country:US
Mailing Address - Phone:843-473-9216
Mailing Address - Fax:888-333-7909
Practice Address - Street 1:69 ROBERT SMALLS PKWY STE 2B
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906
Practice Address - Country:US
Practice Address - Phone:843-473-9216
Practice Address - Fax:888-333-7909
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149931AMedicaid
SCLT1076Medicaid