Provider Demographics
NPI:1689809394
Name:JOHNSON, DEANNE EMILIE (LEP, LPCC, PH)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:EMILIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LEP, LPCC, PH
Other - Prefix:DR
Other - First Name:DEANNE
Other - Middle Name:DUKLETH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:700 GARDEN VIEW COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92011
Mailing Address - Country:US
Mailing Address - Phone:760-310-5509
Mailing Address - Fax:760-814-8004
Practice Address - Street 1:700 GARDEN VIEW COURT
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92011
Practice Address - Country:US
Practice Address - Phone:760-310-5509
Practice Address - Fax:760-814-8004
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1781103TS0200X
CAL.E.P.1781103TS0200X
CALPCC1001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool