Healthcare Provider Details

I. General information

NPI: 1861114431
Provider Name (Legal Business Name): MICHAEL O WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 LIME ST
MAITLAND FL
32751-6939
US

IV. Provider business mailing address

23 RYBAR LN
PALM COAST FL
32164-6445
US

V. Phone/Fax

Practice location:
  • Phone: 407-967-1941
  • Fax:
Mailing address:
  • Phone: 386-314-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24098
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: