Provider Demographics
NPI:1699150433
Name:JOHNSON, BINTA (LGSW)
Entity type:Individual
Prefix:
First Name:BINTA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 HUMBOLDT AVE N APT 317
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1859
Mailing Address - Country:US
Mailing Address - Phone:612-232-9198
Mailing Address - Fax:
Practice Address - Street 1:4050 OLSON MEMORIAL HWY STE 195
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5345
Practice Address - Country:US
Practice Address - Phone:763-522-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN242411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical