Basic Information
Provider Information
NPI: 1952613689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: HERBERT
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 862851
Address2:  
City: ORLANDO
State: FL
PostalCode: 328862851
CountryCode: US
TelephoneNumber: 9548474273
FaxNumber: 9548474245
Practice Location
Address1: 1600 S ANDREWS AVE
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333162510
CountryCode: US
TelephoneNumber: 9543555037
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2010
LastUpdateDate: 07/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH5514FLY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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