Provider Demographics
NPI:1346825916
Name:JOHNSON, KAITLYN MARIE (BSW)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 METRO CIR SW STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5343
Mailing Address - Country:US
Mailing Address - Phone:256-701-4410
Mailing Address - Fax:
Practice Address - Street 1:2117 METRO CIR SW STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5343
Practice Address - Country:US
Practice Address - Phone:256-701-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor