Provider Demographics
NPI:1043449010
Name:WILLIAMS, NICOLE KAFENHAUS (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KAFENHAUS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KAFENHAUS
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465
Mailing Address - Country:US
Mailing Address - Phone:831-246-0069
Mailing Address - Fax:
Practice Address - Street 1:911 21ST STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446
Practice Address - Country:US
Practice Address - Phone:831-222-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53760106H00000X
CA53760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist