Provider Demographics
NPI:1477301711
Name:RUSSELL WILLIAMS, HASSAN MALIK LENARD (APCC)
Entity type:Individual
Prefix:
First Name:HASSAN MALIK
Middle Name:LENARD
Last Name:RUSSELL WILLIAMS
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 59TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2147
Mailing Address - Country:US
Mailing Address - Phone:510-318-0060
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 125D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2424
Practice Address - Country:US
Practice Address - Phone:510-383-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health