Provider Demographics
NPI:1841007317
Name:WILLIAMS, CARL
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3588
Mailing Address - Country:US
Mailing Address - Phone:313-757-0721
Mailing Address - Fax:
Practice Address - Street 1:16130 LITTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4224
Practice Address - Country:US
Practice Address - Phone:131-344-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health