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General NPI Number Information
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NPI Number | 1881077659
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Entity Type | Organization
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Legal Business Name | LATISHA MCWILLIAMS
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 4346 CRESTRIDGE LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-6104
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Country | US
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Telephone | 205-213-5927
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Fax |
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Provider Business Mailing Address
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Address Line | 4346 CRESTRIDGE LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-6104
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Country | US
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Telephone | 205-213-5927
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LATISHA MCWILLIAMS
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Credential | MA, MAED, LPC
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Telephone | 205-213-5927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC006463
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License Number State | GA
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