Provider Demographics
NPI:1508900010
Name:WILLIAMS, MICHAEL EDMOND (MDIV,LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDMOND
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MDIV,LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BIRD MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANDRUM
Mailing Address - State:SC
Mailing Address - Zip Code:29356-9677
Mailing Address - Country:US
Mailing Address - Phone:864-457-2104
Mailing Address - Fax:
Practice Address - Street 1:222 BIRD MOUNTAIN RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANDRUM
Practice Address - State:SC
Practice Address - Zip Code:29356-9677
Practice Address - Country:US
Practice Address - Phone:864-457-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC1322101YP2500X
SC1321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist