Provider Demographics
NPI:1982753513
Name:JOHNSON, NINA M (MFT MARRIAGE AND FAM)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT MARRIAGE AND FAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4312
Mailing Address - Country:US
Mailing Address - Phone:510-581-2522
Mailing Address - Fax:
Practice Address - Street 1:20200 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4312
Practice Address - Country:US
Practice Address - Phone:510-581-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21535103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist