Provider Demographics
NPI:1831889757
Name:NAMACRAY INNER WELLNESS, L.L.C.
Entity type:Organization
Organization Name:NAMACRAY INNER WELLNESS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-C
Authorized Official - Phone:989-370-9157
Mailing Address - Street 1:3813 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8539
Mailing Address - Country:US
Mailing Address - Phone:989-464-0714
Mailing Address - Fax:989-448-2421
Practice Address - Street 1:400 W MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1876
Practice Address - Country:US
Practice Address - Phone:989-370-9157
Practice Address - Fax:888-692-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty