Provider Demographics
NPI:1487034047
Name:JOHNSON, ASHLEY C (CADC-II CA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CADC-II CA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:C
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC-II CA
Mailing Address - Street 1:934 N MOUNTAIN AVE STE B-E
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3659
Mailing Address - Country:US
Mailing Address - Phone:909-949-4667
Mailing Address - Fax:
Practice Address - Street 1:934 N MOUNTAIN AVE STE B-E
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3659
Practice Address - Country:US
Practice Address - Phone:909-949-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5185-R101YA0400X
CAAII31170619101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)