Provider Demographics
NPI:1346391836
Name:WILLING, GERALD ALBERT (MSW)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ALBERT
Last Name:WILLING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:A
Other - Last Name:WILLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:3521 STATE ST
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3267
Mailing Address - Country:US
Mailing Address - Phone:989-791-4066
Mailing Address - Fax:
Practice Address - Street 1:3521 STATE ST
Practice Address - Street 2:SUITE # 3
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3267
Practice Address - Country:US
Practice Address - Phone:989-791-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist