Provider Demographics
NPI:1003081092
Name:WILLIAMS, ELAINE K (MSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18859 SAN QUENTIN DR
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-7812
Mailing Address - Country:US
Mailing Address - Phone:248-557-9449
Mailing Address - Fax:
Practice Address - Street 1:18859 SAN QUENTIN DR
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-7812
Practice Address - Country:US
Practice Address - Phone:248-396-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010178231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0897356OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0N72370Medicare PIN