Healthcare Provider Details

I. General information

NPI: 1275138075
Provider Name (Legal Business Name): DOMINIQUE C JOHNSON LMFT1384
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

IV. Provider business mailing address

7945 SEVILLE CT
BATON ROUGE LA
70820-6520
US

V. Phone/Fax

Practice location:
  • Phone: 337-769-9451
  • Fax:
Mailing address:
  • Phone: 817-271-3168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1384
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: