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General NPI Number Information
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NPI Number | 1750718540
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Entity Type | Individual
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Provider Name | EMILY NICOLE-SPARKS JOHNSON MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 103 BODIN CIR BLDG 778
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1801
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Country | US
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Telephone | 707-437-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 103 BODIN CIR BLDG 778
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1801
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 81731
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License Number State | CA
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