Provider Demographics
NPI:1558132936
Name:MEJIA, NATASHA NICOLE JOHNSON (ASW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE JOHNSON
Last Name:MEJIA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:817 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3851
Mailing Address - Country:US
Mailing Address - Phone:510-435-6870
Mailing Address - Fax:
Practice Address - Street 1:8945 GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:94610
Practice Address - Country:UM
Practice Address - Phone:510-435-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker