Basic Information
| Provider Information | |||||||||
| NPI: | 1902043896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JAYNICE | ||||||||
| MiddleName: | NICHOLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6501 SATSUMA AVE | ||||||||
| Address2: | |||||||||
| City: | N HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916062723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4096924197 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4760 SEPULVEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902304820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107511200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2009 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 65819 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.