Provider Demographics
NPI:1225236466
Name:WILLIAMS, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4432
Mailing Address - Country:US
Mailing Address - Phone:323-514-4105
Mailing Address - Fax:
Practice Address - Street 1:150 EXECUTIVE PARK BLVD
Practice Address - Street 2:STE 4000
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3303
Practice Address - Country:US
Practice Address - Phone:415-715-1050
Practice Address - Fax:415-715-1051
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
171M00000X
CA106025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator