Healthcare Provider Details

I. General information

NPI: 1780382515
Provider Name (Legal Business Name): CORNELIA WILLIAMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 FELT DR
SAVANNAH GA
31419-3105
US

IV. Provider business mailing address

305 FELT DR
SAVANNAH GA
31419-3105
US

V. Phone/Fax

Practice location:
  • Phone: 912-662-6167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CORNELIA WILLIAMS
Title or Position: CEO
Credential: LPC
Phone: 912-662-6167