Healthcare Provider Details

I. General information

NPI: 1740556604
Provider Name (Legal Business Name): TATE (TEELA) WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TATE HENRY WILLIAMS

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 INTERNATIONAL BLVD
OAKLAND CA
94601-2203
US

IV. Provider business mailing address

3033 MAGNOLIA ST
EMERYVILLE CA
94608-4446
US

V. Phone/Fax

Practice location:
  • Phone: 510-433-8600
  • Fax: 510-485-7173
Mailing address:
  • Phone: 510-697-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: