Provider Demographics
NPI:1104309509
Name:WILLIAMS, JONATHON EDWARD (BSW)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15941 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-4123
Mailing Address - Country:US
Mailing Address - Phone:313-345-4310
Mailing Address - Fax:313-345-4315
Practice Address - Street 1:15941 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-4123
Practice Address - Country:US
Practice Address - Phone:313-345-4310
Practice Address - Fax:313-345-4315
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)