Provider Demographics
NPI:1699192435
Name:WILLIAMS BEASLEY, JANET (LPC)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WILLIAMS BEASLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:W
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1020 BARBER CREEK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5983
Mailing Address - Country:US
Mailing Address - Phone:706-257-3004
Mailing Address - Fax:706-257-3001
Practice Address - Street 1:1020 BARBER CREEK DR STE 203
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5983
Practice Address - Country:US
Practice Address - Phone:706-257-3004
Practice Address - Fax:706-257-3001
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007392101YP2500X
GALPC007392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1699192435Medicaid