Provider Demographics
NPI:1396831509
Name:METCALFE, WILLIAM ARTHUR (LICSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:METCALFE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5149
Mailing Address - Country:US
Mailing Address - Phone:218-287-4338
Mailing Address - Fax:218-287-5928
Practice Address - Street 1:1041 HAWK ST
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-6958
Practice Address - Country:US
Practice Address - Phone:218-844-6853
Practice Address - Fax:218-844-6854
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13721041C0700X
MN284721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN153T6MEOtherBCBS
MN623818100Medicaid
ND19119Medicaid