Basic Information
| Provider Information | |||||||||
| NPI: | 1851796254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | SUDRC#8484 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941222210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1566441414 | ||||||||
| FaxNumber: | 4156647741 | ||||||||
| Practice Location | |||||||||
| Address1: | 921 LINCOLN WAY | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941222210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156641414 | ||||||||
| FaxNumber: | 4156647741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2014 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1289390218 | CA | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.