Provider Demographics
NPI:1205961455
Name:JOHNSON, CHRISTINA MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:59 DAMONTE RANCH PKWY # B503
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-1907
Mailing Address - Country:US
Mailing Address - Phone:714-345-1236
Mailing Address - Fax:866-357-8606
Practice Address - Street 1:16897 ALGONQUIN STREET #L
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-3835
Practice Address - Country:US
Practice Address - Phone:714-345-1236
Practice Address - Fax:866-357-8606
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3305-R106H00000X
CAMFC 43740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568168045OtherNPI
CA1972050086OtherGROUP NPI
CAMFC 43740OtherLICENSE