Provider Demographics
NPI:1356813620
Name:JOHNSON, DEAMBRA CHIFFON (BS)
Entity Type:Individual
Prefix:
First Name:DEAMBRA
Middle Name:CHIFFON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:DEAMBRA
Other - Middle Name:CHIFFON
Other - Last Name:JONES-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:7610 40TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3834
Mailing Address - Country:US
Mailing Address - Phone:253-290-7017
Mailing Address - Fax:
Practice Address - Street 1:7610 40TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3834
Practice Address - Country:US
Practice Address - Phone:253-290-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor