Healthcare Provider Details

I. General information

NPI: 1992387005
Provider Name (Legal Business Name): ARLENE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE ROAD BLDG 5513
EDWARDS AFB CA
93524-0001
US

IV. Provider business mailing address

PO BOX 12469
BAKERSFIELD CA
93389-2469
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5292
  • Fax:
Mailing address:
  • Phone: 661-332-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW012481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: