Healthcare Provider Details

I. General information

NPI: 1649333444
Provider Name (Legal Business Name): DEBORAH SUZANNE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEVINS CT
LAKEPORT CA
95453-9754
US

IV. Provider business mailing address

PO BOX 1950
LAKEPORT CA
95453-1950
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8382
  • Fax: 707-263-0329
Mailing address:
  • Phone: 707-263-8382
  • Fax: 707-263-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: