Healthcare Provider Details

I. General information

NPI: 1548782394
Provider Name (Legal Business Name): LACHANDIA NICOLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 FRANKLIN BLVD
SACRAMENTO CA
95823-1820
US

IV. Provider business mailing address

7000 FRANKLIN BLVD,
SACRAMENTO CA
95823
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-9418
  • Fax:
Mailing address:
  • Phone: 916-388-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: