Provider Demographics
NPI:1225585094
Name:JOHNSON, SHERRI LEIGH
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LEIGH
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 1:601 MADISON ST STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6177
Mailing Address - Country:US
Mailing Address - Phone:707-439-7830
Mailing Address - Fax:
Practice Address - Street 1:601 MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6177
Practice Address - Country:US
Practice Address - Phone:707-439-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor