Healthcare Provider Details

I. General information

NPI: 1003241894
Provider Name (Legal Business Name): LIA CHRISTINE JOHANSEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 CONCORD BLVD
CONCORD CA
94519-2608
US

IV. Provider business mailing address

2827 CONCORD BLVD
CONCORD CA
94519-2608
US

V. Phone/Fax

Practice location:
  • Phone: 925-320-3775
  • Fax:
Mailing address:
  • Phone: 925-320-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112048
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: