Provider Demographics
NPI:1417694456
Name:WILLIAMS, MARISA SUE (LLMSW-C)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LLMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W CENTRE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5396
Mailing Address - Country:US
Mailing Address - Phone:269-350-3218
Mailing Address - Fax:
Practice Address - Street 1:1601 W CENTRE AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5396
Practice Address - Country:US
Practice Address - Phone:269-350-3218
Practice Address - Fax:269-323-2558
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511144971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical