Healthcare Provider Details

I. General information

NPI: 1609546795
Provider Name (Legal Business Name): RENEE ANN WILLIAMS A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 EUREKA RD STE 280
ROSEVILLE CA
95661-3093
US

IV. Provider business mailing address

1119 S MISSION RD # 345
FALLBROOK CA
92028-3225
US

V. Phone/Fax

Practice location:
  • Phone: 916-865-6833
  • Fax:
Mailing address:
  • Phone: 916-865-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: RENEE ANN WILLIAMS
Title or Position: PRESIDENT
Credential: LMFT, LPCC
Phone: 916-865-6833