Provider Demographics
NPI:1336380534
Name:WILLIAMS, MICHAEL A (CACIII)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 BANNOCK UNIT #9 MC 3450
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:303-436-3697
Mailing Address - Fax:
Practice Address - Street 1:667 BANNOCK
Practice Address - Street 2:UNIT 9 MC 3450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-436-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2302101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)