Provider Demographics
NPI:1174292809
Name:CARLISA K WILLIAMS, MA,LPC,LLC
Entity Type:Organization
Organization Name:CARLISA K WILLIAMS, MA,LPC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-302-8111
Mailing Address - Street 1:2812 TREYBURN LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-4106
Mailing Address - Country:US
Mailing Address - Phone:248-302-8111
Mailing Address - Fax:
Practice Address - Street 1:2818 TREYBURN LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-4106
Practice Address - Country:US
Practice Address - Phone:248-302-8111
Practice Address - Fax:248-242-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)