Provider Demographics
NPI:1447437736
Name:WILLIAMS, PENNY L
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3707
Mailing Address - Country:US
Mailing Address - Phone:510-236-3139
Mailing Address - Fax:510-236-3200
Practice Address - Street 1:904 MELLUS ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-1745
Practice Address - Country:US
Practice Address - Phone:925-229-0230
Practice Address - Fax:925-229-0233
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070008BN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)