Provider Demographics
NPI:1942955455
Name:JOHNSON, STEPHANIE U
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:U
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE U
Other - Middle Name:JOHNSON
Other - Last Name:YANCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2701 DEL PASO RD 130
Mailing Address - Street 2:250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835
Mailing Address - Country:US
Mailing Address - Phone:916-914-5012
Mailing Address - Fax:
Practice Address - Street 1:1457 DREAMY WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1761
Practice Address - Country:US
Practice Address - Phone:131-050-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1457240222101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)