Provider Demographics
NPI:1710658240
Name:JOHNSON, SARAH MARIA (MHCA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHCA
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:MARIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SARAH JOHNSON
Mailing Address - Street 1:1219 SW GAINES ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2938
Mailing Address - Country:US
Mailing Address - Phone:760-815-2971
Mailing Address - Fax:
Practice Address - Street 1:317 E 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2233
Practice Address - Country:US
Practice Address - Phone:360-546-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC6121581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health