Provider Demographics
NPI:1285077313
Name:JOHNSON, LETITIA (LICSW, CHT, CMHS)
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW, CHT, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 ISSAQUAH PINE LAKE RD SE
Mailing Address - Street 2:# 335
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7253
Mailing Address - Country:US
Mailing Address - Phone:425-891-7891
Mailing Address - Fax:
Practice Address - Street 1:3050 ISSAQUAH PINE LAKE RD SE STE 335
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7253
Practice Address - Country:US
Practice Address - Phone:425-891-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WALW604881701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker