Provider Demographics
NPI:1679940936
Name:JOHNSON, RENAE (LPCC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 W SUNSET BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7308
Mailing Address - Country:US
Mailing Address - Phone:424-283-1845
Mailing Address - Fax:
Practice Address - Street 1:2904 W SUNSET BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7308
Practice Address - Country:US
Practice Address - Phone:424-283-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA6018101YP2500X, 101YM0800X
CA16-199221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist