Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003076100 |
---|---|
Provider Name | Mrs. Varinea Lisett Johnson |
First Address | Covina, CA 91723-3038 |
Second Address | La Verne, CA 91750-2353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 18/01/2018 |