Provider Demographics
NPI:1134594468
Name:WILLIAMS-THORNTON I-IV COUNSEL
Entity type:Organization
Organization Name:WILLIAMS-THORNTON I-IV COUNSEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-435-4135
Mailing Address - Street 1:132 WINNSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5368
Mailing Address - Country:US
Mailing Address - Phone:229-435-4135
Mailing Address - Fax:
Practice Address - Street 1:132 WINNSTEAD DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-5368
Practice Address - Country:US
Practice Address - Phone:229-435-4135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005331251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health