Provider Demographics
NPI:1740266683
Name:WILLIAMS, MICHAEL ALAN (EDD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3015
Mailing Address - Country:US
Mailing Address - Phone:937-254-7301
Mailing Address - Fax:937-254-2117
Practice Address - Street 1:4130 LINDEN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3015
Practice Address - Country:US
Practice Address - Phone:937-254-7301
Practice Address - Fax:937-254-2117
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical