Provider Demographics
NPI:1255978045
Name:WILLIAMS, BARBARA RICHELLE
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:RICHELLE
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 1:1800 BRAINARD ST APT 104
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2863
Mailing Address - Country:US
Mailing Address - Phone:313-422-3984
Mailing Address - Fax:
Practice Address - Street 1:1800 BRAINARD ST APT 104
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2863
Practice Address - Country:US
Practice Address - Phone:313-422-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator