Healthcare Provider Details

I. General information

NPI: 1073460317
Provider Name (Legal Business Name): MARA G JOHNSON MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CAMINO DIABLO
WALNUT CREEK CA
94597-3986
US

IV. Provider business mailing address

PO BOX 1307
LAFAYETTE CA
94549-1307
US

V. Phone/Fax

Practice location:
  • Phone: 925-322-0795
  • Fax:
Mailing address:
  • Phone: 925-322-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARA GEIB JOHNSON
Title or Position: CEO
Credential: MFT
Phone: 925-322-0795