Provider Demographics
NPI:1821140096
Name:JOHNSTON, KADIJA LISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KADIJA
Middle Name:LISA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:735 RAMONA AVE
Mailing Address - Street 2:-
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1817
Mailing Address - Country:US
Mailing Address - Phone:415-206-5082
Mailing Address - Fax:415-206-4722
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:BUILDING 9 ROOM 130
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-5082
Practice Address - Fax:415-206-4722
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
CALCS168131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical