Provider Demographics
NPI:1356584999
Name:JOHNSON, DEZARAE LEANN (ACSW, PPS)
Entity type:Individual
Prefix:
First Name:DEZARAE
Middle Name:LEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACSW, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 SANTA ANA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6533
Mailing Address - Country:US
Mailing Address - Phone:916-752-5890
Mailing Address - Fax:
Practice Address - Street 1:64 E WELDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-5956
Practice Address - Country:US
Practice Address - Phone:559-442-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88176101YM0800X
171M00000X
CA130019225400000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner