Provider Demographics
NPI:1477740363
Name:JOHNSON, DIANNA MARIE (SBHS)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SBHS
Other - Prefix:MRS
Other - First Name:DIANNA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:7885 ANNANDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1419
Mailing Address - Country:US
Mailing Address - Phone:760-329-2924
Mailing Address - Fax:
Practice Address - Street 1:7885 ANNANDALE AVE
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-1419
Practice Address - Country:US
Practice Address - Phone:760-329-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6623101YA0400X
CAAPCC5303101YP2500X
CAAMFT107693106H00000X
CA123779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1014M08OtherTAXOMONY
CA33854Medicaid
CA1477740363OtherNPI
CA1649333030OtherNPI