Provider Demographics
NPI:1083991293
Name:JOHNSON-YOUNG, JILL A (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:JOHNSON-YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 INDIANA AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4298
Mailing Address - Country:US
Mailing Address - Phone:951-778-0230
Mailing Address - Fax:951-823-5134
Practice Address - Street 1:6840 INDIANA AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4298
Practice Address - Country:US
Practice Address - Phone:951-778-0230
Practice Address - Fax:951-823-5134
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical