MEDICARE: MS. KIMBERLY WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	051081	CA

General Provider Information

NPI Number	:	1417131582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY WILLIAMS

Provider Business Mailing Address
First Line	:	2577 MACARTHUR BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2929
Country	:	US
Telephone Number	:	510-482-6490
Fax Number	:	510-482-6493

Provider Business Practice Location Address
First Line	:	4778 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-5210
Country	:	US
Telephone Number	:	510-482-6490
Fax Number	:	510-482-6493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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