Provider Demographics
NPI:1194864934
Name:WILLIAMS, REGINA CORINE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:CORINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 DEL PASO RD # 130-233
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2305
Mailing Address - Country:US
Mailing Address - Phone:916-833-3711
Mailing Address - Fax:
Practice Address - Street 1:2627 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5904
Practice Address - Country:US
Practice Address - Phone:916-833-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF #50399106H00000X
CAMFC #54038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist