Basic Information
| Provider Information | |||||||||
| NPI: | 1184706038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLEY-KING | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW, ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 13TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480606546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109879100 | ||||||||
| FaxNumber: | 8109879105 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 13TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480606546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109879100 | ||||||||
| FaxNumber: | 8109879105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 05/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801-061630 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.