MEDICARE: NIA MARIE 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	101YM0800X	Mental Health Counselor		CA

General Provider Information

NPI Number	:	1760275507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA MARIE WILLIAMS

Provider Business Mailing Address
First Line	:	2291 DUNLOP ST APT 26
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 JUTLAND DR STE 207
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3653
Country	:	US
Telephone Number	:	619-733-6414
Fax Number	:

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

Provider Enumeration Date	:	05/24/2025
Last Update Date	:	05/24/2025

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