Provider Demographics
NPI:1043698020
Name:WILLIAMS, JEFF (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5372
Mailing Address - Country:US
Mailing Address - Phone:701-795-8550
Mailing Address - Fax:701-746-5523
Practice Address - Street 1:1615 17TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5372
Practice Address - Country:US
Practice Address - Phone:701-795-8550
Practice Address - Fax:701-746-5523
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND51321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical