Provider Demographics
NPI:1831689181
Name:JOHNSON, CHARIS TRISHA
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:TRISHA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2620
Mailing Address - Country:US
Mailing Address - Phone:510-457-6566
Mailing Address - Fax:
Practice Address - Street 1:3650 MT DIABLO BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3780
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst