Healthcare Provider Details

I. General information

NPI: 1265179782
Provider Name (Legal Business Name): ALLEINA RAQUEL WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 KANSAS AVE
RIVERSIDE CA
92507-4319
US

IV. Provider business mailing address

3719 KANSAS AVE
RIVERSIDE CA
92507-4319
US

V. Phone/Fax

Practice location:
  • Phone: 951-531-7165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: