Provider Demographics
NPI:1699827147
Name:JOHNSON, CALVIN CREGG I (CADC)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:CREGG
Last Name:JOHNSON
Suffix:I
Gender:M
Credentials:CADC
Other - Prefix:MR
Other - First Name:CALVIN
Other - Middle Name:CREGG
Other - Last Name:JOHNSON
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:CADC
Mailing Address - Street 1:1050 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1259
Mailing Address - Country:US
Mailing Address - Phone:415-740-5590
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5645
Practice Address - Fax:414-206-6875
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)