Provider Demographics
NPI:1932985595
Name:JOHNSON, KENYA R (ACSW, LMSW)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 LINCOLNSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1016
Mailing Address - Country:US
Mailing Address - Phone:714-394-2558
Mailing Address - Fax:
Practice Address - Street 1:4751 LINCOLNSHIRE AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1016
Practice Address - Country:US
Practice Address - Phone:714-394-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1116701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical