Provider Demographics
NPI:1740556604
Name:WILLIAMS, TATE (TEELA)
Entity type:Individual
Prefix:
First Name:TATE (TEELA)
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TATE
Other - Middle Name:HENRY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3033 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4446
Mailing Address - Country:US
Mailing Address - Phone:510-697-7659
Mailing Address - Fax:
Practice Address - Street 1:3001 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2203
Practice Address - Country:US
Practice Address - Phone:510-433-8600
Practice Address - Fax:510-485-7173
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty