Healthcare Provider Details

I. General information

NPI: 1689243826
Provider Name (Legal Business Name): CLARENCE W JOHNSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 400066
HESPERIA CA
92340-0066
US

IV. Provider business mailing address

PO BOX 400066
HESPERIA CA
92340-0066
US

V. Phone/Fax

Practice location:
  • Phone: 909-694-6339
  • Fax:
Mailing address:
  • Phone: 909-694-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: