Provider Demographics
NPI:1235272436
Name:COCHRAN-JOHNSON, LINDA FAYE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:FAYE
Last Name:COCHRAN-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 1:1617 PENTECOST WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-5745
Mailing Address - Country:US
Mailing Address - Phone:619-264-3055
Mailing Address - Fax:
Practice Address - Street 1:1617 PENTECOST WAY APT 1
Practice Address - Street 2:3078 EL CAJON BLVD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-5745
Practice Address - Country:US
Practice Address - Phone:619-264-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)