Provider Demographics
NPI:1629086129
Name:WILLIAMS, GEORGIA ANN (LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGIA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 PHELAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6200
Mailing Address - Country:US
Mailing Address - Phone:409-860-5553
Mailing Address - Fax:409-860-5777
Practice Address - Street 1:5825 PHELAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6200
Practice Address - Country:US
Practice Address - Phone:409-860-5553
Practice Address - Fax:409-860-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health