Healthcare Provider Details

I. General information

NPI: 1639181860
Provider Name (Legal Business Name): HATTIE MAE JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

1303 CORONADO LN
DUNCANVILLE TX
75137-3047
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0702
  • Fax: 214-302-1441
Mailing address:
  • Phone: 972-283-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4095
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: