Healthcare Provider Details

I. General information

NPI: 1255057782
Provider Name (Legal Business Name): CYRSTAL WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD
DETROIT MI
48238-3710
US

IV. Provider business mailing address

24312 TAMARACK CIR
SOUTHFIELD MI
48075-6181
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852093521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: