Provider Demographics
NPI:1730352527
Name:WILLIAMS, TASHA LYNTRICE (MSW)
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:LYNTRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW
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 44805
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0805
Mailing Address - Country:US
Mailing Address - Phone:313-658-3346
Mailing Address - Fax:313-964-2839
Practice Address - Street 1:155 W CONGRESS ST STE 306
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3272
Practice Address - Country:US
Practice Address - Phone:313-964-2648
Practice Address - Fax:866-468-9584
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089872251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health