Provider Demographics
NPI:1003076100
Name:JOHNSON, VARINEA LISETT (MS)
Entity type:Individual
Prefix:MRS
First Name:VARINEA
Middle Name:LISETT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 E ORLANDO WAY
Mailing Address - Street 2:APT C
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3038
Mailing Address - Country:US
Mailing Address - Phone:626-536-2235
Mailing Address - Fax:
Practice Address - Street 1:233 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2353
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:909-833-2986
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor