Provider Demographics
NPI:1356419394
Name:WILLIAMS, JAY C (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1829 EAST FRANKLIN STREET
Mailing Address - Street 2:SUITE 900 A FRANKLIN SQUARE
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-942-8716
Mailing Address - Fax:919-932-9233
Practice Address - Street 1:1829 EAST FRANKLIN STREET
Practice Address - Street 2:SUITE 900 A FRANKLIN SQUARE
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-942-8716
Practice Address - Fax:919-932-9233
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0000731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60318OtherBCBS
NC2864235Medicare ID - Type Unspecified