Provider Demographics
NPI:1760862023
Name:WILLIAMS, EVONNE (LMSW)
Entity Type:Individual
Prefix:
First Name:EVONNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24123 GREENFIELD RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3125
Mailing Address - Country:US
Mailing Address - Phone:248-595-8108
Mailing Address - Fax:248-595-8237
Practice Address - Street 1:24123 GREENFIELD RD
Practice Address - Street 2:SUITE 307
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3125
Practice Address - Country:US
Practice Address - Phone:248-595-8108
Practice Address - Fax:248-595-8237
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086344172V00000X, 1041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker