Provider Demographics
NPI:1427561406
Name:WILLIAMS, TERENCE WENDELL (CMSW)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:WENDELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1113
Mailing Address - Country:US
Mailing Address - Phone:231-893-8336
Mailing Address - Fax:231-981-5277
Practice Address - Street 1:516 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1113
Practice Address - Country:US
Practice Address - Phone:231-893-8336
Practice Address - Fax:231-981-5277
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010900421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical