Provider Demographics
NPI:1093867616
Name:JOHNSON, ANGEL
Entity type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:
Last Name:JOHNSON
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 1:10 DOUGLAS DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4077
Mailing Address - Country:US
Mailing Address - Phone:925-313-1155
Mailing Address - Fax:925-313-1163
Practice Address - Street 1:10 DOUGLAS DR
Practice Address - Street 2:SUITE 140
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4077
Practice Address - Country:US
Practice Address - Phone:925-313-1155
Practice Address - Fax:925-313-1163
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health