| NPI | 1790985042 |
|---|---|
| Former Name | MICKI ANN WILLIAMS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW73368) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW24005) |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW 62549) | |
| 104100000X Social Worker (Licence: CA ASW 62549) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2021-05-11 |