Provider Demographics
NPI:1124438577
Name:WILLIAMS, MARCIA (LMFT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:BONOMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:2227 CAPRICORN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5478
Mailing Address - Country:US
Mailing Address - Phone:707-565-4921
Mailing Address - Fax:
Practice Address - Street 1:2227 CAPRICORN WAY STE 210
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5486
Practice Address - Country:US
Practice Address - Phone:707-565-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106411106H00000X
CAIMF80969106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist