Provider Demographics
NPI:1942823901
Name:WILLIAMS, SUZETTE DELICIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:DELICIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUZETT
Other - Middle Name:DELICIA
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:34 STEEPLE CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-8305
Mailing Address - Country:US
Mailing Address - Phone:470-985-6858
Mailing Address - Fax:678-669-1898
Practice Address - Street 1:147 FORREST PARK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9667
Practice Address - Country:US
Practice Address - Phone:470-985-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011523101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC011523OtherLICENSE