Provider Demographics
NPI:1962986711
Name:WILLIAMS, RACHEL ELEANOR
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELEANOR
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 1:6371 HAVEN AVE # 3358
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6943
Mailing Address - Country:US
Mailing Address - Phone:909-635-5443
Mailing Address - Fax:
Practice Address - Street 1:6371 HAVEN AVE # 3358
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-6943
Practice Address - Country:US
Practice Address - Phone:909-635-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW85413101YM0800X
CALCSW1061171041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106117OtherBOARD OF BEHAVIORAL SCIENCES