Healthcare Provider Details

I. General information

NPI: 1679940936
Provider Name (Legal Business Name): RENAE JOHNSON LPCC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 W SUNSET BLVD STE 6
LOS ANGELES CA
90026-7308
US

IV. Provider business mailing address

2904 W SUNSET BLVD STE 6
LOS ANGELES CA
90026-7308
US

V. Phone/Fax

Practice location:
  • Phone: 424-283-1845
  • Fax:
Mailing address:
  • Phone: 424-283-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16-199
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: