Healthcare Provider Details

I. General information

NPI: 1780340687
Provider Name (Legal Business Name): DELANEY ANTOINE JOHNSON ACSW 113676
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 SKYLINE DR
LEMON GROVE CA
91945-4221
US

IV. Provider business mailing address

2049 SKYLINE DR
LEMON GROVE CA
91945-4221
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-0277
  • Fax:
Mailing address:
  • Phone: 619-442-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113676
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: