Provider Demographics
NPI:1043774615
Name:TIFFANIE W. WILLIAMS. LPC LLC
Entity Type:Organization
Organization Name:TIFFANIE W. WILLIAMS. LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:470-531-8400
Mailing Address - Street 1:12195 HWY 92, STE. 114
Mailing Address - Street 2:#341
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188
Mailing Address - Country:US
Mailing Address - Phone:470-531-8400
Mailing Address - Fax:470-531-8484
Practice Address - Street 1:251 RIVER PARK NORTH DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-7835
Practice Address - Country:US
Practice Address - Phone:470-531-8400
Practice Address - Fax:470-531-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003218462AMedicaid