Provider Demographics
NPI:1285983593
Name:WILLIAMS, DANIELLE LEIGH (TLLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEIGH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 M-89
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078
Mailing Address - Country:US
Mailing Address - Phone:269-692-2100
Mailing Address - Fax:269-692-2101
Practice Address - Street 1:1387 M-89
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MI
Practice Address - Zip Code:49078
Practice Address - Country:US
Practice Address - Phone:269-692-2100
Practice Address - Fax:269-692-2101
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014423103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling