Provider Demographics
NPI:1326559204
Name:JOHNSON, CEASAR MELVIN
Entity Type:Individual
Prefix:
First Name:CEASAR
Middle Name:MELVIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1542
Mailing Address - Country:US
Mailing Address - Phone:510-881-5921
Mailing Address - Fax:510-291-9591
Practice Address - Street 1:24301 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1542
Practice Address - Country:US
Practice Address - Phone:510-881-5921
Practice Address - Fax:510-291-9591
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)