Healthcare Provider Details

I. General information

NPI: 1508554767
Provider Name (Legal Business Name): ANGELA LUCILLE JOHNSON BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 LEE ST
ALEXANDRIA LA
71302-3235
US

IV. Provider business mailing address

4606 LEE ST
ALEXANDRIA LA
71302-3235
US

V. Phone/Fax

Practice location:
  • Phone: 318-441-1105
  • Fax: 318-441-2251
Mailing address:
  • Phone: 318-441-1105
  • Fax: 318-441-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: