Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 16877 | WI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | WI |
NPI | 1073188793 |
---|---|
Provider Name | Melody Williams |
First Address | Waukesha, WI 53186-4832 |
Second Address | Waukesha, WI 53186-4832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2021 |
Last Update Date | 27/10/2021 |