Provider Demographics
NPI:1306345251
Name:WILLIAMS, PHYLLIS LISA
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:LISA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 WINDY HILL RD SE STE 416
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8625
Mailing Address - Country:US
Mailing Address - Phone:347-395-2185
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE STE 416
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8625
Practice Address - Country:US
Practice Address - Phone:347-395-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health