Basic Information
| Provider Information | |||||||||
| NPI: | 1932379518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JACARRIAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19401 S VERMONT AVE STE A200 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905024418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103236887 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 W VICTORIA ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908052175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232425000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C082899137 | OK | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | AMF87473 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 87473 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 122173 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.