Provider Demographics
NPI:1316435324
Name:WILLIAMS, NITAUSHA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:NITAUSHA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NITAUSHA
Other - Middle Name:
Other - Last Name:HETH-CERMAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:JACKSON RECOVERY CENTERS, INC.
Mailing Address - Street 2:800 5TH STREET
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101
Mailing Address - Country:US
Mailing Address - Phone:712-234-2341
Mailing Address - Fax:712-234-2395
Practice Address - Street 1:JACKSON RECOVERY CENTERS, INC.
Practice Address - Street 2:800 5TH STREET
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101
Practice Address - Country:US
Practice Address - Phone:712-234-2300
Practice Address - Fax:712-234-2392
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0882811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical