Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LPC007096 | GA |
NPI | 1003220013 |
---|---|
Provider Name | Lakeisha Renae Williams |
First Address | Atlanta, GA 30318-0527 |
Second Address | Atlanta, GA 30318-0527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 17/06/2014 |