Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003109497 |
---|---|
Provider Name | Mrs. Krista Williams |
First Address | Canon, GA 30520-2142 |
Second Address | Canon, GA 30520-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 18/05/2011 |