Provider Demographics
NPI:1598274193
Name:WILLIAMS, MELISSA RILEY (RBT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RILEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RILEY
Other - Last Name:ELROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:300 SHADOW WOOD PARK STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:205-773-0977
Practice Address - Street 1:300 SHADOW WOOD PARK STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3411
Practice Address - Country:US
Practice Address - Phone:205-733-0976
Practice Address - Fax:205-733-0977
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17-28881106S00000X
ALRBT-17-28881106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty