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General NPI Number Information
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NPI Number | 1366932675
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Entity Type | Individual
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Provider Name | ANTIONE J WILLIAMS LLMSW
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Gender | Male
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 415 S LAFAYETTE ST
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City | SOUTH LYON
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State | MI
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Zip | 48178-1458
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Country | US
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Telephone | 248-573-7417
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Fax |
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Provider Business Mailing Address
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Address Line | 16004 TERRACE VILLAGE DR
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City | TAYLOR
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State | MI
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Zip | 48180-4904
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Country | US
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Telephone | 313-820-0046
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851107550
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License Number State | MI
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