Provider Demographics
NPI:1831606441
Name:JOHNSON, JAMIE ANN CYNTHIA (AOD COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANN CYNTHIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AOD COUNSELOR
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANN CYNTHIA
Other - Last Name:DE SOUSA DIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AOD COUNSELOR
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:951-588-4106
Mailing Address - Fax:
Practice Address - Street 1:5870 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2037
Practice Address - Country:US
Practice Address - Phone:951-465-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1260770817101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)