Provider Demographics
NPI:1043639446
Name:WILLIAMSON, ISAAC (LMSW)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 COLLEGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2134
Mailing Address - Country:US
Mailing Address - Phone:734-216-0688
Mailing Address - Fax:
Practice Address - Street 1:1205 COLLEGEWOOD ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2134
Practice Address - Country:US
Practice Address - Phone:734-216-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02603101YA0400X
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)