Provider Demographics
NPI:1558927848
Name:SUNNY JOHNSON, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:SUNNY JOHNSON, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-452-3373
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty