Provider Demographics
NPI:1689925646
Name:WILLIAMS, GUY R (LLPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LLPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S LIVERNOIS RD
Mailing Address - Street 2:SUITE C-21
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2578
Mailing Address - Country:US
Mailing Address - Phone:248-652-4799
Mailing Address - Fax:
Practice Address - Street 1:455 S LIVERNOIS RD
Practice Address - Street 2:SUITE C-21
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2578
Practice Address - Country:US
Practice Address - Phone:248-652-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6401014247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467648535Medicare PIN