Provider Demographics
NPI:1780154021
Name:WILLIAMS, MARCIE (MS, CHW)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-3136
Mailing Address - Country:US
Mailing Address - Phone:843-453-3776
Mailing Address - Fax:
Practice Address - Street 1:411 E 3RD ST STE 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2006
Practice Address - Country:US
Practice Address - Phone:810-232-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No172V00000XOther Service ProvidersCommunity Health Worker