Provider Demographics
NPI:1013742154
Name:WILLIAMS, TRYNAISHA LARRINE
Entity type:Individual
Prefix:
First Name:TRYNAISHA
Middle Name:LARRINE
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 1:12835 PLUMBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1645
Mailing Address - Country:US
Mailing Address - Phone:586-467-2306
Mailing Address - Fax:
Practice Address - Street 1:2785 E GRAND BLVD STE 536
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-2003
Practice Address - Country:US
Practice Address - Phone:586-467-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851114937104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker