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General NPI Number Information
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NPI Number | 1376924514
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Entity Type | Individual
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Provider Name | CASSANDRA LATASHA JOHNSON PHD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2015
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 630 ELLIS ST STE 3A
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City | AUGUSTA
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State | GA
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Zip | 30901-1464
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Country | US
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Telephone | 706-550-0723
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Fax | 706-739-4624
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Provider Business Mailing Address
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Address Line | 630 ELLIS ST STE 3A
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City | AUGUSTA
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State | GA
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Zip | 30901-1464
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Country | US
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Telephone | 706-550-0723
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Fax | 706-739-4624
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC010321
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License Number State | GA
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