Provider Demographics
NPI:1912327925
Name:WILLIAMS, KYA (MS BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 MACON RD STE 18-19
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-8200
Mailing Address - Country:US
Mailing Address - Phone:706-221-5253
Mailing Address - Fax:
Practice Address - Street 1:3575 MACON RD STE 18-19
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-8200
Practice Address - Country:US
Practice Address - Phone:706-221-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003195560AMedicaid