Healthcare Provider Details

I. General information

NPI: 1053665125
Provider Name (Legal Business Name): TIMOTHY ALAN WILLIAMS MDIV, DMIN, MA, ACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 GRAND RIVER AVE
DETROIT MI
48204-2139
US

IV. Provider business mailing address

1572 HIGHWAY 85 NORTH STE 335-PMB 3031
FAYETTEVILLE GA
30214-7729
US

V. Phone/Fax

Practice location:
  • Phone: 678-870-5515
  • Fax: 678-870-5515
Mailing address:
  • Phone: 678-870-5515
  • Fax: 678-870-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: