Provider Demographics
NPI:1609759356
Name:WILLIAMS, LENNIE BERNARD JR
Entity type:Individual
Prefix:
First Name:LENNIE
Middle Name:BERNARD
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 FALCON CHASE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3195
Mailing Address - Country:US
Mailing Address - Phone:678-458-2342
Mailing Address - Fax:
Practice Address - Street 1:2534 FALCON CHASE CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3195
Practice Address - Country:US
Practice Address - Phone:678-458-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-431325106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician