Provider Demographics
NPI:1053328849
Name:JOHNSON, ORCHID DANESHMAND (MS)
Entity Type:Individual
Prefix:MRS
First Name:ORCHID
Middle Name:DANESHMAND
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:ORCHID
Other - Middle Name:ZAHRA
Other - Last Name:DANESHMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2271 W MALVERN AVE # 213
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2106
Mailing Address - Country:US
Mailing Address - Phone:714-420-4891
Mailing Address - Fax:
Practice Address - Street 1:2701 E CHAPMAN AVE
Practice Address - Street 2:SUITE #209
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3734
Practice Address - Country:US
Practice Address - Phone:714-420-4891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44504106H00000X
MAMFT1389106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist