Provider Demographics
NPI:1225620479
Name:PEARSON, JOHNNY (RADT)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 S ARCHER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2421
Mailing Address - Country:US
Mailing Address - Phone:657-456-0261
Mailing Address - Fax:
Practice Address - Street 1:1153 DELAY ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-1913
Practice Address - Country:US
Practice Address - Phone:714-757-4266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARH0006150121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)