Provider Demographics
NPI:1194903799
Name:WILLIAMS, MICHAEL DEMETRIUS (MSW, CSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEMETRIUS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PRESS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1085
Mailing Address - Country:US
Mailing Address - Phone:504-255-6192
Mailing Address - Fax:
Practice Address - Street 1:6400 PRESS DRIVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1085
Practice Address - Country:US
Practice Address - Phone:504-255-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1194908799Other1990