Stacey Dawn Williamson Nichols, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6801088675 Issued in MI

Practice address

3001 Fuller Ave NE Ste 1
Grand Rapids, MI 49505-3204

Phone

(616) 426-2328

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pine Rest Christian Mental Health Services

  • Social Worker
  • Grand Rapids, MI
  • NPI 1922019157
  Medicare reassignment NPD
• SWN Therapy LLC

  • Social Worker
  • Grand Rapids, MI
  • NPI 1124665484
  Medicare reassignment NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1508945577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "MASON",
            "state": "MI",
            "postal_code": "488540010",
            "telephone_number": "517-676-9788",
            "fax_number": "517-676-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 FULLER AVE NE STE 1",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053204",
            "telephone_number": "616-426-2328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6921 Scott Woods Ct NE",
            "address_purpose": "LOCATION",
            "city": "Comstock Park",
            "state": "MI",
            "postal_code": "493219620",
            "country_code": "US",
            "telephone_number": "616-426-2328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMSON NICHOLS",
        "first_name": "STACEY",
        "middle_name": "DAWN",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801088675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1715928",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelby A Williams
• Shelby Katherine Williams, LMSW
• Shianne Williams
• Stephanie F Williams, MD
• Zoila V Williams, LMT
• Abigail Williamson
• Faith Marie Williamson
• Myles Alan Williamson
• Sara Willingham, SLP
• Erin Marie Willink, NP

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.