Provider Demographics
NPI:1316967276
Name:WILLIAMS, MICHAEL RAY (BS, CADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:MRS
Other - First Name:ROSEANN
Other - Middle Name:
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:631 S BROOKHURST ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3510
Mailing Address - Country:US
Mailing Address - Phone:714-490-7711
Mailing Address - Fax:714-490-7717
Practice Address - Street 1:631 S BROOKHURST ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3510
Practice Address - Country:US
Practice Address - Phone:714-490-7711
Practice Address - Fax:714-490-7717
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2008605101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)