Healthcare Provider Details

I. General information

NPI: 1700578705
Provider Name (Legal Business Name): LAKEITHA JOHNSON LCSW, MSW, CAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E 12TH AVE
DENVER CO
80220-2415
US

IV. Provider business mailing address

18638 E 42ND AVE
DENVER CO
80249-7268
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-7700
  • Fax:
Mailing address:
  • Phone: 720-296-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932436
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: