Provider Demographics
NPI:1609754720
Name:JOHNSON, JUSTINE MARIE (RADT)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 STEELE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3127
Mailing Address - Country:US
Mailing Address - Phone:707-576-0818
Mailing Address - Fax:
Practice Address - Street 1:625 STEELE LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3127
Practice Address - Country:US
Practice Address - Phone:707-576-0818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1611430525101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)