Provider Demographics
NPI:1871740662
Name:WILLIAMS, LADORA M (RN, LMFT)
Entity type:Individual
Prefix:
First Name:LADORA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, LMFT
Other - Prefix:
Other - First Name:LADORA
Other - Middle Name:M
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LMFT
Mailing Address - Street 1:1501 KRAFFT RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3565
Mailing Address - Country:US
Mailing Address - Phone:810-985-5125
Mailing Address - Fax:810-985-5127
Practice Address - Street 1:1501 KRAFFT RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3565
Practice Address - Country:US
Practice Address - Phone:810-985-5125
Practice Address - Fax:810-985-5127
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G46345Medicare PIN