Provider Demographics
NPI:1710328794
Name:JOHNSON-SPENCER, LAWANA J
Entity Type:Individual
Prefix:
First Name:LAWANA
Middle Name:J
Last Name:JOHNSON-SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15108 MORENO BEACH DR
Mailing Address - Street 2:414
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6382
Mailing Address - Country:US
Mailing Address - Phone:951-224-2553
Mailing Address - Fax:
Practice Address - Street 1:9990 COUNTY FARM ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-358-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist