Provider Demographics
NPI:1396155149
Name:WILLIAMS, ANDRA (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649
Mailing Address - Country:US
Mailing Address - Phone:231-360-7785
Mailing Address - Fax:231-642-5525
Practice Address - Street 1:954 BUSINESS PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-8763
Practice Address - Country:US
Practice Address - Phone:231-360-7785
Practice Address - Fax:231-642-5525
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional