=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023431509
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MRWILL & COMPANY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2014
-----------------------------------------------------
Last Update Date | 10/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8880 CAL CENTER DR STE 400
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-438-6950
-----------------------------------------------------
Fax | 916-438-6951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8880 CAL CENTER DR STE 400
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-3267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-438-6950
-----------------------------------------------------
Fax | 916-438-6951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MATTHEW R WILLIAMS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 916-438-6950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 27812
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------