Provider Demographics
NPI:1215998257
Name:KEARNS, WILLIAM LAWBENCE (LMSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LAWBENCE
Last Name:KEARNS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:49059-4134
Mailing Address - Country:US
Mailing Address - Phone:810-385-9944
Mailing Address - Fax:
Practice Address - Street 1:1322 NORTH RIVER RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010040911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI743206Medicaid
MI743206Medicaid