Provider Demographics
NPI:1023353422
Name:JOHNSON, HERSTINE (RAS)
Entity type:Individual
Prefix:
First Name:HERSTINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E COMPTON BLVD
Mailing Address - Street 2:# 115
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3403
Mailing Address - Country:US
Mailing Address - Phone:310-669-8673
Mailing Address - Fax:
Practice Address - Street 1:1450 E COMPTON BLVD
Practice Address - Street 2:# 115
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3403
Practice Address - Country:US
Practice Address - Phone:310-669-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-J0505021432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)