Healthcare Provider Details

I. General information

NPI: 1659714020
Provider Name (Legal Business Name): CHERINA LETICE WILLIAMS CCCSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 WESTPORT CIR
DISCOVERY BAY CA
94505-2678
US

IV. Provider business mailing address

14850 CA-4 STE A 226
DISCOVERY BAY CA
94505
US

V. Phone/Fax

Practice location:
  • Phone: 510-629-1061
  • Fax:
Mailing address:
  • Phone: 404-839-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: