Provider Demographics
NPI:1376126839
Name:WILLIAMS, REGINALD LEE
Entity Type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:LEE
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 1:9101 NEWHALL DR APT 4
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-5364
Mailing Address - Country:US
Mailing Address - Phone:916-307-8705
Mailing Address - Fax:916-307-8705
Practice Address - Street 1:9101 NEWHALL DR APT NEWHALL
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-5363
Practice Address - Country:US
Practice Address - Phone:916-307-8705
Practice Address - Fax:916-307-8705
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker