Healthcare Provider Details

I. General information

NPI: 1710003744
Provider Name (Legal Business Name): LINDA JOHNSON LMFT, LAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S ELLSWORTH AVE UNIT 477
SAN MATEO CA
94401-4096
US

IV. Provider business mailing address

210 S ELLSWORTH AVE UNIT 477
SAN MATEO CA
94401-4096
US

V. Phone/Fax

Practice location:
  • Phone: 707-506-6707
  • Fax:
Mailing address:
  • Phone: 707-506-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR420311
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: