Provider Demographics
NPI:1083181564
Name:WILLIAMS-TYSON, MEATRIA
Entity Type:Individual
Prefix:
First Name:MEATRIA
Middle Name:
Last Name:WILLIAMS-TYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MEATRIA
Other - Middle Name:
Other - Last Name:WILLIAMS-TYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3399 PEACHTREE RD NE STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-2825
Mailing Address - Country:US
Mailing Address - Phone:410-534-2141
Mailing Address - Fax:888-449-6523
Practice Address - Street 1:3399 PEACHTREE RD NE STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-2825
Practice Address - Country:US
Practice Address - Phone:410-534-2141
Practice Address - Fax:888-449-6523
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC10084101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA254139400Medicaid