Provider Demographics
NPI:1932409372
Name:JOHNSON, KAREN LYNETTE (MHC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9442 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1444
Mailing Address - Country:US
Mailing Address - Phone:510-777-8448
Mailing Address - Fax:510-777-8453
Practice Address - Street 1:9442 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1444
Practice Address - Country:US
Practice Address - Phone:510-777-8448
Practice Address - Fax:510-777-8453
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health