Provider Demographics
NPI:1477017366
Name:WILLIAMS, LEONTYNE GULLEY (MFTA)
Entity Type:Individual
Prefix:
First Name:LEONTYNE
Middle Name:GULLEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 BLACKBERRY GLN
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-4255
Mailing Address - Country:US
Mailing Address - Phone:205-587-7040
Mailing Address - Fax:
Practice Address - Street 1:566 BLACKBERRY GLN
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-4255
Practice Address - Country:US
Practice Address - Phone:205-587-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL32062211OtherALABAMA DEPARTMENT OF HUMAN RESOURCES
AL32060768OtherALABAMA DEPARTMENT OF HUMAN RESOURCES