Provider Demographics
NPI:1518412667
Name:PHYLLIS WILLIAMS, LMFT, PC
Entity Type:Organization
Organization Name:PHYLLIS WILLIAMS, LMFT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:770-710-7335
Mailing Address - Street 1:2107 N DECATUR RD
Mailing Address - Street 2:205
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:770-710-7335
Mailing Address - Fax:
Practice Address - Street 1:2308 PERIMETER PARK DR
Practice Address - Street 2:100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1316
Practice Address - Country:US
Practice Address - Phone:770-457-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891981320Medicaid