Provider Demographics
NPI:1275242646
Name:JOHNSON, FABIOLA (AMFT)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7502
Mailing Address - Country:US
Mailing Address - Phone:661-204-8296
Mailing Address - Fax:
Practice Address - Street 1:9556 LANGDON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2103
Practice Address - Country:US
Practice Address - Phone:310-930-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist