Provider Demographics
NPI:1063621530
Name:LOVELESS, WILLIAM CULLEN (BA, CAC-I)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CULLEN
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:BA, CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1805
Mailing Address - Country:US
Mailing Address - Phone:989-652-0082
Mailing Address - Fax:
Practice Address - Street 1:3169 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6805
Practice Address - Country:US
Practice Address - Phone:810-785-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI250297101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)