Provider Demographics
NPI:1972761096
Name:JOHNSON, WALANDA LASHEA (MS)
Entity type:Individual
Prefix:MISS
First Name:WALANDA
Middle Name:LASHEA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GILEAD RD # 408
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6899
Mailing Address - Country:US
Mailing Address - Phone:619-887-4210
Mailing Address - Fax:
Practice Address - Street 1:400 GILEAD RD
Practice Address - Street 2:408
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2870
Practice Address - Country:US
Practice Address - Phone:619-887-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100082106H00000X
NC2403106H00000X
CAIMF62954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist