Provider Demographics
NPI:1750832606
Name:WILLIAMS, STEPHANIE EVETTE
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:EVETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CARRIAGE LAKE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6290
Mailing Address - Country:US
Mailing Address - Phone:404-372-8941
Mailing Address - Fax:
Practice Address - Street 1:125 S ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3335
Practice Address - Country:US
Practice Address - Phone:678-432-3330
Practice Address - Fax:678-432-3662
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health