Provider Demographics
NPI:1710281456
Name:WILLIAMS, MICHELE (CSAC, CS-IT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSAC, CS-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 N BREMEN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3003
Mailing Address - Country:US
Mailing Address - Phone:414-977-1200
Mailing Address - Fax:414-962-2305
Practice Address - Street 1:2618 N BREMEN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3003
Practice Address - Country:US
Practice Address - Phone:414-977-1200
Practice Address - Fax:414-962-2305
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15240-130101YA0400X
WI15443-132101YA0400X
WI15465-133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)