Healthcare Provider Details

I. General information

NPI: 1942363585
Provider Name (Legal Business Name): MS. GINNED WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 MITCHELL RD STE 301
CERES CA
95307-2156
US

IV. Provider business mailing address

1705 GARIBALDI CT
MODESTO CA
95358-7137
US

V. Phone/Fax

Practice location:
  • Phone: 209-353-4838
  • Fax:
Mailing address:
  • Phone: 470-246-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: