Provider Demographics
NPI:1447444195
Name:WILLIAMS, TRACY JADE (MA)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:JADE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CIELO LN
Mailing Address - Street 2:#204
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-3300
Mailing Address - Country:US
Mailing Address - Phone:415-827-5654
Mailing Address - Fax:
Practice Address - Street 1:120 CIELO LN
Practice Address - Street 2:#204
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-3300
Practice Address - Country:US
Practice Address - Phone:415-827-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist