Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 6401010505 | MI |
Y | 102L00000X | Psychologist | 6301013669 | MI |
Y | 103T00000X | Psychologist | 6301013669 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1-04794 | MI |
NPI | 1578960449 |
---|---|
Provider Name | Janet Marie Williams |
First Address | Muskegon, MI 49442-4837 |
Second Address | Whitehall, MI 49461-1104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 20/11/2014 |