Provider Demographics
NPI:1205275633
Name:WILLIAMS, RENISEYA DELIAH (LLP)
Entity type:Individual
Prefix:
First Name:RENISEYA
Middle Name:DELIAH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28501 FRANKLIN RD APT 338
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1637
Mailing Address - Country:US
Mailing Address - Phone:313-502-0796
Mailing Address - Fax:
Practice Address - Street 1:20997 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6662
Practice Address - Country:US
Practice Address - Phone:313-502-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361003420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist