Healthcare Provider Details

I. General information

NPI: 1376763409
Provider Name (Legal Business Name): DEBRA JOHNSON CASII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 02/21/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE UNIT 311
FRESNO CA
93705-4218
US

IV. Provider business mailing address

2550 W CLINTON AVE UNIT 311
FRESNO CA
93705-4218
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax:
Mailing address:
  • Phone: 559-264-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII4771214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: