Provider Demographics
NPI:1346488244
Name:JOHNSON, JUANITA LOUISE (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3625
Mailing Address - Country:US
Mailing Address - Phone:504-466-3848
Mailing Address - Fax:
Practice Address - Street 1:3218 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3625
Practice Address - Country:US
Practice Address - Phone:504-466-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA25381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical