MEDICARE: LATISHA MCWILLIAMS

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	251S00000X	Community/Behavioral Health Agency	LPC006463	GA

General Provider Information

NPI Number	:	1881077659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LATISHA MCWILLIAMS

Provider Business Mailing Address
First Line	:	4346 CRESTRIDGE LN
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-6104
Country	:	US
Telephone Number	:	205-213-5927
Fax Number	:

Provider Business Practice Location Address
First Line	:	4346 CRESTRIDGE LN
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-6104
Country	:	US
Telephone Number	:	205-213-5927
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	LATISHA MCWILLIAMS
Credential	:	MA, MAED, LPC
Telephone Number	:	205-213-5927

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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