=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114544038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AIMEE D. WILLIAMS MHS, LPC, CRC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2020
-----------------------------------------------------
Last Update Date | 05/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5835 CAMPBELLTON RD SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-666-9261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5835 CAMPBELLTON RD SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30331-8013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-666-9261
-----------------------------------------------------
Fax | 866-404-2691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 004738
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------