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General NPI Number Information
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NPI Number | 1740647874
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Entity Type | Organization
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Legal Business Name | HEATHER JOHNSON
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 9815 CARROLL CANYON RD SUITE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1123
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Country | US
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Telephone | 858-863-6790
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Fax | 267-417-1530
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Provider Business Mailing Address
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Address Line | 9815 CARROLL CANYON RD SUITE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1123
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Country | US
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Telephone | 858-863-6790
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Fax | 267-417-1530
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. HEATHER JOHNSON
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Credential | PHD
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Telephone | 858-863-6790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY27023
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License Number State | CA
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