Provider Demographics
NPI:1639311202
Name:WILLIAMSON, GWENDOLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:4337 E GRAND RIVER AVE
Mailing Address - Street 2:# 147
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6583
Mailing Address - Country:US
Mailing Address - Phone:248-379-6975
Mailing Address - Fax:248-319-1143
Practice Address - Street 1:1125 E MILHAM AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3096
Practice Address - Country:US
Practice Address - Phone:269-312-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010794491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical