Provider Demographics
NPI:1891102935
Name:WILLIAMS, MISTY (EDS, LPC, CADC II)
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDS, LPC, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 CARLY WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7739
Mailing Address - Country:US
Mailing Address - Phone:404-357-4617
Mailing Address - Fax:
Practice Address - Street 1:6886 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4508
Practice Address - Country:US
Practice Address - Phone:404-357-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007334101YM0800X, 101YP2500X
101YA0400X
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)