Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PSY23518 | CA |
N | 103G00000X | Clinical Psychologist | PSY23518 | CA |
N | 103TC0700X | Clinical Psychologist | PSY23518 | CA |
N | 102L00000X | Psychologist | PSY23518 | CA |
N | 103T00000X | Psychologist | PSY23518 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY23518 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSY23518 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY23518 | CA |
Y | 103G00000X | Clinical Psychologist | PSY23518 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY23518 | CA |
N | 103TC1900X | Counseling Psychologist | PSY23518 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY23518 | CA |
N | 103TF0000X | Family Psychologist | PSY23518 | CA |
N | 103TF0200X | Forensic Psychologist | PSY23518 | CA |
NPI | 1124322797 |
---|---|
Provider Name | Dr. Virginia Johnson |
First Address | Fresno, CA 93704-2515 |
Second Address | Fresno, CA 93704-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 22/12/2010 |