Provider Demographics
NPI:1689125882
Name:WILLIAMS, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 N HURON RIVER DR
Mailing Address - Street 2:APT 12
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2366
Mailing Address - Country:US
Mailing Address - Phone:330-412-7836
Mailing Address - Fax:
Practice Address - Street 1:1126 N HURON RIVER DR
Practice Address - Street 2:APT 12
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2366
Practice Address - Country:US
Practice Address - Phone:330-412-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTT821407106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician