Provider Demographics
NPI:1770018715
Name:WILLIAMS, LATORSHA
Entity Type:Individual
Prefix:
First Name:LATORSHA
Middle Name:
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 1:223 N ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4440
Mailing Address - Country:US
Mailing Address - Phone:478-289-2530
Mailing Address - Fax:478-289-2532
Practice Address - Street 1:223 N ANDERSON DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4440
Practice Address - Country:US
Practice Address - Phone:478-289-2530
Practice Address - Fax:478-289-2532
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health