Provider Demographics
NPI:1447764691
Name:WILLIAMS, TEVIS HOWARD (LLPC)
Entity Type:Individual
Prefix:MR
First Name:TEVIS
Middle Name:HOWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29807 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5734
Mailing Address - Country:US
Mailing Address - Phone:313-282-3696
Mailing Address - Fax:
Practice Address - Street 1:29807 ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5734
Practice Address - Country:US
Practice Address - Phone:313-282-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor