Healthcare Provider Details

I. General information

NPI: 1629666979
Provider Name (Legal Business Name): TARIEN WILLIAMS LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 FULLER AVE NE STE 208
GRAND RAPIDS MI
49505-3458
US

IV. Provider business mailing address

2920 FULLER AVE NE STE 208
GRAND RAPIDS MI
49505-3458
US

V. Phone/Fax

Practice location:
  • Phone: 616-551-2916
  • Fax: 616-383-9009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023847
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: