Healthcare Provider Details

I. General information

NPI: 1497232235
Provider Name (Legal Business Name): MS. REGINA LORAINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22245 MAIN ST STE 200
HAYWARD CA
94541-4028
US

IV. Provider business mailing address

22245 MAIN ST STE 200
HAYWARD CA
94541-4028
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-9401
  • Fax:
Mailing address:
  • Phone: 510-727-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: