Provider Demographics
NPI:1881376861
Name:WILLIAMS, CEDRIC LAVELL (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:LAVELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 CREEKVIEW GLN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3665
Mailing Address - Country:US
Mailing Address - Phone:901-550-5642
Mailing Address - Fax:
Practice Address - Street 1:2222 CREEKVIEW GLN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3665
Practice Address - Country:US
Practice Address - Phone:901-550-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician