Provider Demographics
NPI:1366299943
Name:WILLIAMSON, CALEY WILLIAMSON
Entity type:Individual
Prefix:
First Name:CALEY
Middle Name:WILLIAMSON
Last Name:WILLIAMSON
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 1:390 CASTLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-6020
Mailing Address - Country:US
Mailing Address - Phone:470-497-4582
Mailing Address - Fax:
Practice Address - Street 1:390 CASTLEMAN RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-6020
Practice Address - Country:US
Practice Address - Phone:470-497-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB1102829106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician