Provider Demographics
NPI:1275118507
Name:STYLES, WILLEM L (LMSW)
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:L
Last Name:STYLES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 IRIS DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6602
Mailing Address - Country:US
Mailing Address - Phone:470-252-8270
Mailing Address - Fax:
Practice Address - Street 1:990 IRIS DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6602
Practice Address - Country:US
Practice Address - Phone:470-252-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker