Provider Demographics
NPI:1114375656
Name:KWAN, JOANNA (MA, LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KWAN
Suffix:
Gender:F
Credentials:MA, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11344 COLOMA RD STE 560
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6304
Mailing Address - Country:US
Mailing Address - Phone:916-287-3604
Mailing Address - Fax:916-357-9722
Practice Address - Street 1:11344 COLOMA RD STE 560
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-6304
Practice Address - Country:US
Practice Address - Phone:916-287-3604
Practice Address - Fax:916-357-9722
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92385106H00000X
CA9216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist