MEDICARE: TYEISHA WILLIAMS-MILLS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW009748	GA

General Provider Information

NPI Number	:	1104702422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYEISHA WILLIAMS-MILLS LCSW

Provider Business Mailing Address
First Line	:	110 FRANKLIN RD
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-5519
Country	:	US
Telephone Number	:	678-438-7055
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 FRANKLIN RD
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-5519
Country	:	US
Telephone Number	:	678-438-7055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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