Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003045030 |
---|---|
Provider Name | Miss Jessica Ann Williams |
First Address | Brooklyn, NY 11218-2354 |
Second Address | New York, NY 10038-4812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2009 |
Last Update Date | 13/07/2009 |