Healthcare Provider Details

I. General information

NPI: 1689189136
Provider Name (Legal Business Name): CANDIS E-NAE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CONNER ST
DETROIT MI
48215-2201
US

IV. Provider business mailing address

830 N SUMMIT ST STE 2
TOLEDO OH
43604-1884
US

V. Phone/Fax

Practice location:
  • Phone: 313-273-4111
  • Fax:
Mailing address:
  • Phone: 419-693-9600
  • Fax: 419-693-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: