Provider Demographics
NPI:1578960449
Name:WILLIAMS, JANET MARIE (LLP, LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 S WOLF LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4837
Mailing Address - Country:US
Mailing Address - Phone:231-903-7775
Mailing Address - Fax:
Practice Address - Street 1:516 E COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1104
Practice Address - Country:US
Practice Address - Phone:231-893-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010505101YP2500X
MI6301013669103T00000X
MI1-04794103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)