Individual provider · Type 1 NPI

Jacqueline Mary Williston, LPC, LCDC

Professional Counselor · Azle, TX

NPI number 1780305102 Active

Practice location

173 W Main St Ste 6
Azle, TX 76020-3117

Call (817) 381-2290 Map

Fax (888) 909-5191

Mailing address

901 Clinic Dr Ste A110
Euless, TX 76039-7453

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400X15454 (TX)
Professional Counselor Primary 101YP2500X85356 (TX)

Professional Counselor: Definition to come...

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About NPI 1780305102

Jacqueline Mary Williston, LPC, LCDC's National Provider Identifier is 1780305102, issued on Sep 5, 2022. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Azle, TX. The record was last updated on Sep 5, 2022.