Provider Demographics
NPI:1841741485
Name:PHYLLIS WILLIAMS, LMFT, PC
Entity Type:Organization
Organization Name:PHYLLIS WILLIAMS, LMFT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:770-710-7335
Mailing Address - Street 1:2107 N DECATUR RD
Mailing Address - Street 2:205
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:770-710-7335
Mailing Address - Fax:
Practice Address - Street 1:209 SWANTON WAY STE A
Practice Address - Street 2:102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3274
Practice Address - Country:US
Practice Address - Phone:770-710-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYLLIS WILLIAMS, LMFT, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty