Provider Demographics
NPI:1194556290
Name:ALEXANDER-JOHNSON, LASTACIE DESHON
Entity type:Individual
Prefix:
First Name:LASTACIE
Middle Name:DESHON
Last Name:ALEXANDER-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 1:7127 LEENS LODGE LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3344
Mailing Address - Country:US
Mailing Address - Phone:832-450-1611
Mailing Address - Fax:
Practice Address - Street 1:7127 LEENS LODGE LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3344
Practice Address - Country:US
Practice Address - Phone:832-450-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor