Provider Demographics
NPI:1679167845
Name:WILLIAMS, RENEE ANN (LMFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5098 FOOTHILLS BLVD # 3-134
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6526
Mailing Address - Country:US
Mailing Address - Phone:916-865-6833
Mailing Address - Fax:
Practice Address - Street 1:2200 DOUGLAS BLVD STE 140B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4292
Practice Address - Country:US
Practice Address - Phone:916-865-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2024-12-12
Deactivation Date:2021-03-24
Deactivation Code:
Reactivation Date:2021-06-16
Provider Licenses
StateLicense IDTaxonomies
ID8572106H00000X
AZ15738106H00000X
CA124536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist