Provider Demographics
NPI:1871331827
Name:WILLIAMS-JACKSON, CHARLOTTE CAROL (PCC)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:CAROL
Last Name:WILLIAMS-JACKSON
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14004 WIMBLEDON LOOP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5750
Mailing Address - Country:US
Mailing Address - Phone:501-952-9268
Mailing Address - Fax:
Practice Address - Street 1:207 PROGRESS WAY STE 102
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-8810
Practice Address - Country:US
Practice Address - Phone:501-952-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR374J00000X
VA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No374J00000XNursing Service Related ProvidersDoula