Provider Demographics
NPI:1477669778
Name:IRVING, WILLIAM CLIFFORD III (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLIFFORD
Last Name:IRVING
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22811 GREATER MACK AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2021
Mailing Address - Country:US
Mailing Address - Phone:586-443-4402
Mailing Address - Fax:586-443-4412
Practice Address - Street 1:22811 GREATER MACK AVE
Practice Address - Street 2:STE 202
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2021
Practice Address - Country:US
Practice Address - Phone:586-443-4402
Practice Address - Fax:586-443-4412
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWI002945103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist