Provider Demographics
NPI:1891981320
Name:WILLIAMS, PHYLLIS DEVON (MA)
Entity Type:Individual
Prefix:MISS
First Name:PHYLLIS
Middle Name:DEVON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40719101YM0800X, 106H00000X
AL101YM0800X
GAMFT001192106H00000X, 101YM0800X
ALL336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist