Basic Information
| Provider Information | |||||||||
| NPI: | 1215290069 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 609001 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921609001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195284600 | ||||||||
| FaxNumber: | 6195284625 | ||||||||
| Practice Location | |||||||||
| Address1: | 1061 TIERRA DEL REY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919107880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194985454 | ||||||||
| FaxNumber: | 6194985455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 02/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904007884 | VA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 28894 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.