Provider Demographics
NPI:1114128279
Name:JOHNSON, SHERI R
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MAPLE WAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1849
Mailing Address - Country:US
Mailing Address - Phone:510-472-3215
Mailing Address - Fax:510-235-3112
Practice Address - Street 1:820 23RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1338
Practice Address - Country:US
Practice Address - Phone:510-229-5000
Practice Address - Fax:510-235-3112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)