Provider Demographics
NPI:1306619093
Name:WILLIAMS, TYKERA JA'RISSE (MSW, LSWAIC)
Entity type:Individual
Prefix:MRS
First Name:TYKERA
Middle Name:JA'RISSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76020 WILLIAM BURGESS BLVD UNIT 5-1098
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5489
Mailing Address - Country:US
Mailing Address - Phone:410-463-9857
Mailing Address - Fax:
Practice Address - Street 1:75067 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-1607
Practice Address - Country:US
Practice Address - Phone:410-463-9857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW615022871041C0700X
WASC609702831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical