Provider Demographics
NPI:1295414498
Name:JOHNSON, LEMARCUS DEON
Entity type:Individual
Prefix:
First Name:LEMARCUS
Middle Name:DEON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 BROOKHOLLOW DR STE 80
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5421
Mailing Address - Country:US
Mailing Address - Phone:562-754-5736
Mailing Address - Fax:
Practice Address - Street 1:1526 BROOKHOLLOW DR STE 80
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5421
Practice Address - Country:US
Practice Address - Phone:562-754-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker