Healthcare Provider Details

I. General information

NPI: 1215179593
Provider Name (Legal Business Name): SHEILLA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N RAMONA BLVD SUITE 5
SAN JACINTO CA
92582-2567
US

IV. Provider business mailing address

950 N RAMONA BLVD SUITE 5
SAN JACINTO CA
92582-2567
US

V. Phone/Fax

Practice location:
  • Phone: 951-663-4842
  • Fax:
Mailing address:
  • Phone: 951-663-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: