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General NPI Number Information
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NPI Number | 1326636416
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Entity Type | Individual
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Provider Name | JUDY LORRAINE JOHNSON-FORSETH RADT-I
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 838 BEACH CT
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City | COLOMA
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State | CA
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Zip | 95667-4625
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Country | US
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Telephone | 530-626-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 838 BEACH COURT
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City | LOTUS
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State | CA
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Zip | 95651-3415
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Country | US
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Telephone | 530-626-7252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1414511220
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License Number State | CA
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