Provider Demographics
NPI:1215552864
Name:WILLIAMS, NICOLE BETH (MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WHITNEY CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95633-9532
Mailing Address - Country:US
Mailing Address - Phone:916-541-2374
Mailing Address - Fax:
Practice Address - Street 1:701 HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4734
Practice Address - Country:US
Practice Address - Phone:530-830-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health