Healthcare Provider Details

I. General information

NPI: 1861685471
Provider Name (Legal Business Name): ALVIN WYNN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COOLIDGE AVE FRED FINCH YOUTH CENTER
OAKLAND CA
94602-3311
US

IV. Provider business mailing address

5063 MIDWAY RD
VACAVILLE CA
95688-9697
US

V. Phone/Fax

Practice location:
  • Phone: 510-482-2244
  • Fax:
Mailing address:
  • Phone: 707-678-4375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberN3610781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: