Provider Demographics
NPI:1265168629
Name:WILLIAMS, KIM LATRELLE (BS, MS)
Entity type:Individual
Prefix:MISS
First Name:KIM
Middle Name:LATRELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:LATRELLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MARSHALL
Mailing Address - Street 1:501 OLD RICHMOND RD APT 522
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-9296
Mailing Address - Country:US
Mailing Address - Phone:205-401-7201
Mailing Address - Fax:
Practice Address - Street 1:600 COMMERCIAL CT STE AVENUE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3674
Practice Address - Country:US
Practice Address - Phone:912-352-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)