Provider Demographics
NPI:1962134841
Name:WILLIAMS, NICOLAS CAMERON (PHD, LPC, NCC)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:CAMERON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 NW 120TH TER APT 432
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-0674
Mailing Address - Country:US
Mailing Address - Phone:336-253-8529
Mailing Address - Fax:
Practice Address - Street 1:671 NW 120TH TER APT 432
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-0674
Practice Address - Country:US
Practice Address - Phone:336-253-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional