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General NPI Number Information
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NPI Number | 1194271452
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Entity Type | Individual
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Provider Name | KENNETH DARNELL LORENZO WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 20311 WESTMORELAND RD
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City | DETROIT
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State | MI
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Zip | 48219-1476
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Country | US
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Telephone | 248-416-8234
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Fax |
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Provider Business Mailing Address
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Address Line | 20311 WESTMORELAND RD
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City | DETROIT
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State | MI
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Zip | 48219-1476
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Country | US
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Telephone | 248-416-8234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | 452465135450
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7501006081
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License Number State | MI
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