Healthcare Provider Details

I. General information

NPI: 1346709995
Provider Name (Legal Business Name): RONNIE WILLIAMS AMFT154471 APCC19081
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ALPINE BLVD STE A
ALPINE CA
91901-1101
US

IV. Provider business mailing address

PO BOX 117
POWAY CA
92074-0117
US

V. Phone/Fax

Practice location:
  • Phone: 619-448-1216
  • Fax: 888-291-4799
Mailing address:
  • Phone: 619-438-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6107
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC19081
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT154471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: