Provider Demographics
NPI:1942943444
Name:MCWILLIAMS, DESTINEY ROSE
Entity Type:Individual
Prefix:
First Name:DESTINEY
Middle Name:ROSE
Last Name:MCWILLIAMS
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 1:500 QUARTER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1960
Mailing Address - Country:US
Mailing Address - Phone:989-313-3395
Mailing Address - Fax:
Practice Address - Street 1:500 QUARTER ST APT 3
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1960
Practice Address - Country:US
Practice Address - Phone:989-313-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling