Provider Demographics
NPI:1679067714
Name:WILLIAMS, BETTY BROWN (LPC)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:BROWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7204 WRENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-5009
Mailing Address - Country:US
Mailing Address - Phone:706-573-2231
Mailing Address - Fax:
Practice Address - Street 1:4 BRADLEY PARK CT STE 1H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3634
Practice Address - Country:US
Practice Address - Phone:706-327-1222
Practice Address - Fax:706-327-1444
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA57-0957571Medicaid