Healthcare Provider Details

I. General information

NPI: 1477301711
Provider Name (Legal Business Name): HASSAN MALIK LENARD RUSSELL WILLIAMS APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125D
OAKLAND CA
94605-2424
US

IV. Provider business mailing address

1258 59TH ST APT 8
EMERYVILLE CA
94608-2147
US

V. Phone/Fax

Practice location:
  • Phone: 510-383-5100
  • Fax:
Mailing address:
  • Phone: 510-318-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC16178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: