Provider Demographics
NPI:1891424354
Name:WILLIAMS, TIA L
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W LAYTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2651
Mailing Address - Country:US
Mailing Address - Phone:414-573-1443
Mailing Address - Fax:
Practice Address - Street 1:1651 S COACHLIGHT DR UNIT B
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1478
Practice Address - Country:US
Practice Address - Phone:414-573-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker