Provider Demographics
NPI:1538371398
Name:JOHNSON, PATTI SUE (CATS)
Entity type:Individual
Prefix:
First Name:PATTI
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 MARCONI AVE
Mailing Address - Street 2:APT #6
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1828 TRIBUTE RD
Practice Address - Street 2:SUITE H
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4310
Practice Address - Country:US
Practice Address - Phone:916-564-4400
Practice Address - Fax:916-564-4424
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)