Provider Demographics
NPI:1871725069
Name:WILLIAMS, MICHELLE R (CADA UNDER SUP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CADA UNDER SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14962 COUNTY ROAD 3599
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3145
Mailing Address - Country:US
Mailing Address - Phone:580-436-3504
Mailing Address - Fax:580-435-5047
Practice Address - Street 1:605 E 12TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6605
Practice Address - Country:US
Practice Address - Phone:580-436-3504
Practice Address - Fax:580-436-5047
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)