Provider Demographics
NPI:1427325505
Name:DOLLISON-JOHNSON, DANETTE R (MA, LPC, MT-BC)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:R
Last Name:DOLLISON-JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5327
Mailing Address - Country:US
Mailing Address - Phone:504-610-9018
Mailing Address - Fax:
Practice Address - Street 1:203 SIERRA CT
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5327
Practice Address - Country:US
Practice Address - Phone:504-610-9018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional