Healthcare Provider Details

I. General information

NPI: 1144853011
Provider Name (Legal Business Name): DERHONDA L WILLIAMS-KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29200 NORTHWESTERN HWY STE 110
SOUTHFIELD MI
48034-1055
US

IV. Provider business mailing address

15600 19 MILE RD
CLINTON TOWNSHIP MI
48038-3502
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8700
  • Fax: 586-412-7889
Mailing address:
  • Phone: 586-263-8700
  • Fax: 586-412-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6802090750
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: