Healthcare Provider Details

I. General information

NPI: 1891478574
Provider Name (Legal Business Name): ROSHAWNDA ELERIA JOHNSON ACSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 QUEBEC AVE
CORCORAN CA
93212-9715
US

IV. Provider business mailing address

21711 S FIGUEROA ST APT 417
CARSON CA
90745
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-7111
  • Fax:
Mailing address:
  • Phone: 248-872-7829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: