Provider Demographics
NPI:1508158577
Name:JOHNSON, SUNNY (LCSW)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:BATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3711 LONG BEACH BLVD STE 5043
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3315
Mailing Address - Country:US
Mailing Address - Phone:562-452-3373
Mailing Address - Fax:562-264-0977
Practice Address - Street 1:3711 LONG BEACH BLVD STE 5043
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3315
Practice Address - Country:US
Practice Address - Phone:562-452-3373
Practice Address - Fax:562-264-0977
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 613781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical