Doctor Name: | MS. DIVINA THEODOSIA JOHNSTON |
NPI Number: | 1154649390 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 90 Via Juana Rd Santa Ynez, CA - 934609679 |
Business Phone Number: | 8056887070 |
Business Fax Number: | 8056862060 |
Mailing Address: | Po Box 539, SANTA YNEZ |
State: | CA |
Postal Code: | 934600539 |
Phone Number: | 8056887070 |
Fax Number: | 8056862060 |
NPI Enumeration Date: | 05/12/2010 |
NPI Last Update Date: | 06/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |