Provider Demographics
NPI:1316160005
Name:WILLIAMS, JACQUELINE YVONNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:YVONNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:YVONNE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3800 BIG BEND TRL
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-3001
Mailing Address - Country:US
Mailing Address - Phone:863-984-6383
Mailing Address - Fax:863-984-6383
Practice Address - Street 1:3800 BIG BEND TRL
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-3001
Practice Address - Country:US
Practice Address - Phone:863-984-6383
Practice Address - Fax:863-984-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical