Provider Demographics
NPI:1801090808
Name:JOHNSON, DANALYNN LORRAINE
Entity type:Individual
Prefix:
First Name:DANALYNN
Middle Name:LORRAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DANALYNN
Other - Middle Name:LORRAINE
Other - Last Name:TILLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2310 BULLION DR
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-5022
Mailing Address - Country:US
Mailing Address - Phone:760-309-2694
Mailing Address - Fax:
Practice Address - Street 1:73501 29 PALMS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-3100
Practice Address - Country:US
Practice Address - Phone:760-367-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker