Provider Demographics
NPI:1679762272
Name:JOHNSON, DANIELLE KRISTEN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KRISTEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 ARLINGTON AVE
Mailing Address - Street 2:STE. 106
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3943
Mailing Address - Country:US
Mailing Address - Phone:951-345-9293
Mailing Address - Fax:
Practice Address - Street 1:27720 JEFFERSON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2610
Practice Address - Country:US
Practice Address - Phone:951-506-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44524106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist