Healthcare Provider Details

I. General information

NPI: 1417447863
Provider Name (Legal Business Name): ERNIE MICHAEL WILLIAMS CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 INDEPENDENCE DR
HAZARD KY
41701-9443
US

IV. Provider business mailing address

1182 HIGHWAY 3410
MAYKING KY
41837-9066
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-1646
  • Fax: 606-487-1746
Mailing address:
  • Phone: 606-899-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number118110
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: