Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003241894 |
---|---|
Provider Name | Ms. Lia Christine Johansen |
First Address | Pleasant Hill, CA 94523-4341 |
Second Address | Pleasant Hill, CA 94523-4341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2013 |
Last Update Date | 19/11/2015 |