Provider Demographics
NPI:1760983191
Name:WILLIAMS, JENNA JANETT NICOLE (LPCC-S)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:JANETT NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-1204
Mailing Address - Country:US
Mailing Address - Phone:270-963-1207
Mailing Address - Fax:
Practice Address - Street 1:310 CARDINAL LANE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-8661
Practice Address - Country:US
Practice Address - Phone:270-963-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional