Provider Demographics
NPI:1114314929
Name:WILLIAMS, TIESHA N
Entity Type:Individual
Prefix:
First Name:TIESHA
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 19TH ST
Mailing Address - Street 2:APT. A4
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-4777
Mailing Address - Country:US
Mailing Address - Phone:706-571-9128
Mailing Address - Fax:706-571-9242
Practice Address - Street 1:1220 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-5241
Practice Address - Country:US
Practice Address - Phone:706-571-9128
Practice Address - Fax:706-571-9242
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor