Provider Demographics
NPI:1457819492
Name:WILLIAMS, LATOYA (SUDRC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SUNRISE AVENUE
Mailing Address - Street 2:BUILDING 200, STE-201
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4553
Mailing Address - Country:US
Mailing Address - Phone:916-782-3737
Mailing Address - Fax:
Practice Address - Street 1:730 SUNRISE AVENUE
Practice Address - Street 2:BUILDING 200, STE-201
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4553
Practice Address - Country:US
Practice Address - Phone:530-878-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)