Provider Demographics
NPI:1033506886
Name:WILLIAMS, PENNY (MSLLP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 BUCKTHORN CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8689
Mailing Address - Country:US
Mailing Address - Phone:517-414-3343
Mailing Address - Fax:
Practice Address - Street 1:3367 BUCKTHORN CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8689
Practice Address - Country:US
Practice Address - Phone:517-414-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008806101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health