Provider Demographics
NPI:1033395462
Name:WILLIAMS, MICHAEL A SR (PC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1459
Mailing Address - Country:US
Mailing Address - Phone:937-247-0518
Mailing Address - Fax:
Practice Address - Street 1:210 E COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-1459
Practice Address - Country:US
Practice Address - Phone:937-247-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC-0600657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health