Healthcare Provider Details

I. General information

NPI: 1669993895
Provider Name (Legal Business Name): LETICIA VACA WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 LA SALLE AVE STE 208
OAKLAND CA
94611-2802
US

IV. Provider business mailing address

3569 LYON AVE
OAKLAND CA
94601-3839
US

V. Phone/Fax

Practice location:
  • Phone: 510-369-5909
  • Fax:
Mailing address:
  • Phone: 510-367-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number77386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: