Basic Information
Provider Information | |||||||||
NPI: | 1528043965 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCWILLIAMS | ||||||||
FirstName: | CYNTHIA | ||||||||
MiddleName: | Q | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JAMES | ||||||||
OtherFirstName: | CYNTHIA | ||||||||
OtherMiddleName: | DOYLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2121 A BELLEVUE RD | ||||||||
Address2: |   | ||||||||
City: | DUBLIN | ||||||||
State: | GA | ||||||||
PostalCode: | 31021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4782721190 | ||||||||
FaxNumber: | 4782756509 | ||||||||
Practice Location | |||||||||
Address1: | 940 GA HIGHWAY 96 | ||||||||
Address2: |   | ||||||||
City: | WARNER ROBINS | ||||||||
State: | GA | ||||||||
PostalCode: | 310882584 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4789881222 | ||||||||
FaxNumber: | 4789888098 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/08/2005 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 000744 | GA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.