Provider Demographics
NPI:1194395996
Name:JOHNSON, QUENTINA OLINTHIA
Entity Type:Individual
Prefix:MS
First Name:QUENTINA
Middle Name:OLINTHIA
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 1:1437 PLYMOUTH ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-2400
Mailing Address - Country:US
Mailing Address - Phone:559-776-7349
Mailing Address - Fax:
Practice Address - Street 1:3845 N CLARK ST STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4842
Practice Address - Country:US
Practice Address - Phone:559-621-2121
Practice Address - Fax:559-457-1188
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC9821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health