Provider Demographics
NPI:1972636975
Name:WILLIAMS, SHANETTE ROSE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SHANETTE
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S OAK AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3572
Mailing Address - Country:US
Mailing Address - Phone:209-605-1610
Mailing Address - Fax:209-322-2290
Practice Address - Street 1:250 S OAK AVE STE A1
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3572
Practice Address - Country:US
Practice Address - Phone:209-605-1610
Practice Address - Fax:209-322-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist