Basic Information
| Provider Information | |||||||||
| NPI: | 1821158817 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1309 S. LINDEN RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106301152 | ||||||||
| FaxNumber: | 8106309107 | ||||||||
| Practice Location | |||||||||
| Address1: | 1309 S. LINDEN RD. | ||||||||
| Address2: | SUITE C | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106301152 | ||||||||
| FaxNumber: | 8106309107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301007038 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 750910736 | 01 | MI | BLUE SHIELD OPC | OTHER | 0B51092 | 01 | MI | BLUE SHIELD | OTHER |