Provider Demographics
NPI:1558947663
Name:WILLIAMS, KASEY LYNN (DP-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9413
Mailing Address - Country:US
Mailing Address - Phone:906-203-5007
Mailing Address - Fax:
Practice Address - Street 1:863 N PINE RD STE A
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2159
Practice Address - Country:US
Practice Address - Phone:989-928-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)