Individual
MS. JENNIFER WATERS WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
878 COUNTRY CLUB RD, ROCKY MOUNT, NC 27804-1707
(252) 314-7021
Mailing address
112 ASHMORE LANE, ROCKY MOUNT, NC 27804-1774
(252) 451-1171
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
4038
NC
103TC0700X
Clinical Psychologist
1388
NC
103TC0700X
Clinical Psychologist
Primary
4038
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015WA
BCBS OF NC
NC
01
—
1427010578
MEDICARE
NC
01
—
2826021
MEDICARE PTAN
NC
01
—
561396133
MEDCOST
NC
Enumeration date
08/27/2006
Last updated
01/19/2021
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