Healthcare Provider Details

I. General information

NPI: 1659285674
Provider Name (Legal Business Name): ALICIA A JOHNSON MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12129 GARFIELD AVE # 2393
SOUTH GATE CA
90280-8000
US

IV. Provider business mailing address

12129 GARFIELD AVE # 2393
SOUTH GATE CA
90280-8000
US

V. Phone/Fax

Practice location:
  • Phone: 323-680-9669
  • Fax:
Mailing address:
  • Phone: 323-680-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW140603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: