Healthcare Provider Details

I. General information

NPI: 1124817812
Provider Name (Legal Business Name): LISA M GWILLIAM LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 GREENWICH AVE
WARWICK RI
02886-1815
US

IV. Provider business mailing address

819 GREENWICH AVE
WARWICK RI
02886-1815
US

V. Phone/Fax

Practice location:
  • Phone: 404-268-4007
  • Fax: 888-972-3966
Mailing address:
  • Phone: 404-268-4007
  • Fax: 888-972-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: