Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801017823 | MI |
NPI | 1003081092 |
---|---|
Provider Name | Ms. Elaine K Williams |
First Address | Lathrup Village, MI 48076-7812 |
Second Address | Lathrup Village, MI 48076-7812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0897356 | BLUE CROSS BLUE SHIELD OF MICHIGAN (01) | MI |