Provider Demographics
NPI:1063440204
Name:BURNES, WILLIAM L (LMSW, ACSW, CAADC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:BURNES
Suffix:
Gender:M
Credentials:LMSW, ACSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HAMBURG RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9160
Mailing Address - Country:US
Mailing Address - Phone:248-231-3568
Mailing Address - Fax:
Practice Address - Street 1:794 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2392
Practice Address - Country:US
Practice Address - Phone:248-231-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI97456000Medicare ID - Type Unspecified