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General NPI Number Information
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NPI Number | 1356584999
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Entity Type | Individual
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Provider Name | DEZARAE LEANN JOHNSON ACSW, PPS
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Gender | Female
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 64 E WELDON AVE
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City | FRESNO
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State | CA
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Zip | 93704-5956
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Country | US
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Telephone | 559-442-1947
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Fax |
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Provider Business Mailing Address
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Address Line | 2437 SANTA ANA AVE
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City | CLOVIS
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State | CA
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Zip | 93611-6533
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Country | US
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Telephone | 916-752-5890
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88176
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 130019
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 130019
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License Number State | CA
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