Provider Demographics
NPI:1700024957
Name:WILLIAMS, GEORGE QUENTIN JR (SST)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:QUENTIN
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17420 PENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2615
Mailing Address - Country:US
Mailing Address - Phone:313-443-1218
Mailing Address - Fax:
Practice Address - Street 1:2751 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4180
Practice Address - Country:US
Practice Address - Phone:313-993-3434
Practice Address - Fax:313-993-3421
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803085479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker