Provider Demographics
NPI:1700626157
Name:WILLIAMS-PHILLIPS, MALYA RACHELLE (BT)
Entity type:Individual
Prefix:
First Name:MALYA
Middle Name:RACHELLE
Last Name:WILLIAMS-PHILLIPS
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:MALIYAH
Other - Middle Name:RACHELLE
Other - Last Name:WILLIAMS-PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:137 JOHNSON FERRY RD STE 2170
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4948
Mailing Address - Country:US
Mailing Address - Phone:470-648-0150
Mailing Address - Fax:470-317-2127
Practice Address - Street 1:137 JOHNSON FERRY RD STE 2170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4948
Practice Address - Country:US
Practice Address - Phone:470-648-0150
Practice Address - Fax:470-317-2127
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician