Provider Demographics
NPI:1760716856
Name:WILLIAMS, MARQUETTA LEONA (BSW,MA)
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:LEONA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSW,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1533
Mailing Address - Country:US
Mailing Address - Phone:313-869-6905
Mailing Address - Fax:313-883-6159
Practice Address - Street 1:2409 CALVERT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1533
Practice Address - Country:US
Practice Address - Phone:313-869-6908
Practice Address - Fax:313-883-6159
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008988101Y00000X
MI6802086235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker