Provider Demographics
NPI:1679228142
Name:WILLIAMS, CHARLESE (APC)
Entity Type:Individual
Prefix:
First Name:CHARLESE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 WINDY HILL RD SE STE 105
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8608
Mailing Address - Country:US
Mailing Address - Phone:678-460-7606
Mailing Address - Fax:
Practice Address - Street 1:2480 WINDY HILL RD SE STE 105
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8608
Practice Address - Country:US
Practice Address - Phone:678-460-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health