Provider Demographics
NPI:1346888971
Name:WILLIAMS, LATAMIKA RENEE
Entity Type:Individual
Prefix:
First Name:LATAMIKA
Middle Name:RENEE
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 1:1710 GA-16 WEST
Mailing Address - Street 2:#6
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-229-3407
Mailing Address - Fax:
Practice Address - Street 1:1710 GA-16 WEST
Practice Address - Street 2:#6
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-229-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health