Provider Demographics
NPI:1306567219
Name:JOHNSON-NGUYEN, NICOLE CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:JOHNSON-NGUYEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2607
Mailing Address - Country:US
Mailing Address - Phone:310-874-4134
Mailing Address - Fax:
Practice Address - Street 1:1945 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3443
Practice Address - Country:US
Practice Address - Phone:310-874-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist