MEDICARE: VENEISHA DEBBIAN JOHNSON ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	45571	CA
2	106H00000X	Marriage & Family Therapist	47382	CA

General Provider Information

NPI Number	:	1265593925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENEISHA DEBBIAN JOHNSON ED.D

Provider Business Mailing Address
First Line	:	2460 CLAY BANK RD BLDG 9
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-1655
Country	:	US
Telephone Number	:	707-701-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 CLAY BANK RD BLDG 9
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-1655
Country	:	US
Telephone Number	:	707-701-0820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/04/2024

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