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NPI Code Detail

MEDICARE: JEFFERY ALLAN JOHNSON CADC-CAS

MEDICARE: JEFFERY ALLAN JOHNSON CADC-CAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorC5131214CA

General Provider Information

NPI Number : 1578005393
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY ALLAN JOHNSON CADC-CAS
Provider Business Mailing Address
First Line : 180 SIERRA COLLEGE DR
Second Line :
City : GRASS VALLEY
State : CA
Zip : 95945-5768
Country : US
Telephone Number : 530-273-9541
Fax Number :
Provider Business Practice Location Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-273-9541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2016
Last Update Date : 01/16/2020

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