Healthcare Provider Details

I. General information

NPI: 1457704777
Provider Name (Legal Business Name): MS. CORLETTE VANESSA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125A
OAKLAND CA
94605-2457
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125A
OAKLAND CA
94605-2457
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-3800
  • Fax: 510-777-3806
Mailing address:
  • Phone: 510-777-3800
  • Fax: 510-777-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: