Provider Demographics
NPI:1134466584
Name:JOHNSON-ROSALES, DEBORAH R
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:JOHNSON-ROSALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BS,LCDC
Mailing Address - Street 1:410 S MAIN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1128
Mailing Address - Country:US
Mailing Address - Phone:210-822-9493
Mailing Address - Fax:210-822-8733
Practice Address - Street 1:410 S MAIN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1128
Practice Address - Country:US
Practice Address - Phone:210-822-9493
Practice Address - Fax:210-822-8733
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional