MEDICARE: DAVID WILLIAMS CPSS, CPRC, LLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		MI
2	175T00000X	Peer Specialist		MI

General Provider Information

NPI Number	:	1770340994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WILLIAMS CPSS, CPRC, LLMSW

Provider Business Mailing Address
First Line	:	707 W MILWAUKEE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-2943
Country	:	US
Telephone Number	:	313-344-9099
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 PIQUETTE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3513
Country	:	US
Telephone Number	:	313-576-1580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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