Provider Demographics
NPI:1417216805
Name:WILLIAMS, VICKIE M (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:VICKIE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:VICKIE
Other - Middle Name:
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:20061 EVERGREEN MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4214
Mailing Address - Country:US
Mailing Address - Phone:313-231-1528
Mailing Address - Fax:
Practice Address - Street 1:20061 EVERGREEN MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4214
Practice Address - Country:US
Practice Address - Phone:313-231-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68010671671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical