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General NPI Number Information
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NPI Number | 1013173673
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Entity Type | Individual
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Provider Name | LARAE A WILLIAMS PSY.D
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE SUITE #540
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 678-825-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 BUFORD HWY NE SUITE #540
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | GA003466
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License Number State | GA
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