Provider Demographics
NPI:1043973209
Name:LEE-JOHNSON, APRESHANA MATAYSHA WILINA
Entity type:Individual
Prefix:MRS
First Name:APRESHANA
Middle Name:MATAYSHA WILINA
Last Name:LEE-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 1:342 W RICHERT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-5049
Mailing Address - Country:US
Mailing Address - Phone:559-598-4733
Mailing Address - Fax:
Practice Address - Street 1:2747 N REDDA RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93737-9619
Practice Address - Country:US
Practice Address - Phone:559-375-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator