Provider Demographics
NPI:1437708815
Name:WILLIAMS, JAZMINE NIYAE
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:NIYAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 PEBBLE CRK E APT 12
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-6202
Mailing Address - Country:US
Mailing Address - Phone:586-480-9059
Mailing Address - Fax:
Practice Address - Street 1:4943 PEBBLE CRK E APT 12
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-6202
Practice Address - Country:US
Practice Address - Phone:586-480-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical