Healthcare Provider Details

I. General information

NPI: 1093862880
Provider Name (Legal Business Name): REBECCA A JOHNSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NATHALIE ST
LAFAYETTE LA
70506-3540
US

IV. Provider business mailing address

132 ALONDA DR
LAFAYETTE LA
70503-4228
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-2433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3572
License Number StateLA

VIII. Authorized Official

Name: REBECCA JOHNSON
Title or Position: LCSW
Credential:
Phone: 337-781-2186