Provider Demographics
NPI:1659714020
Name:WILLIAMS, CHERINA LETICE (CCCSLP)
Entity Type:Individual
Prefix:
First Name:CHERINA
Middle Name:LETICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ESTUDILLO AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4900
Mailing Address - Country:US
Mailing Address - Phone:404-839-0420
Mailing Address - Fax:
Practice Address - Street 1:400 ESTUDILLO AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4900
Practice Address - Country:US
Practice Address - Phone:404-839-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist