Provider Demographics
NPI:1982069407
Name:IVIE-WILLIAMS, RICHE' (LPC)
Entity Type:Individual
Prefix:
First Name:RICHE'
Middle Name:
Last Name:IVIE-WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:
Other - Last Name:IVIE-WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3255 JODECO PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-5352
Mailing Address - Country:US
Mailing Address - Phone:740-538-8363
Mailing Address - Fax:
Practice Address - Street 1:1445 WOODMONT LN NW # 887
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2866
Practice Address - Country:US
Practice Address - Phone:740-538-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional