Healthcare Provider Details

I. General information

NPI: 1093458564
Provider Name (Legal Business Name): CLARHONDA WILLIAMSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30986 STONE RIDGE DR APT 14213
WIXOM MI
48393-3891
US

IV. Provider business mailing address

30986 STONE RIDGE DR APT 14213
WIXOM MI
48393-3891
US

V. Phone/Fax

Practice location:
  • Phone: 248-993-4937
  • Fax:
Mailing address:
  • Phone: 248-993-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851109943
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: