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General NPI Number Information
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NPI Number | 1447994090
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Entity Type | Individual
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Provider Name | KENNITRA MARIE JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 576 BELLE TERRE BLVD
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City | LA PLACE
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State | LA
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Zip | 70068-1715
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Country | US
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Telephone | 504-493-2271
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Fax | 985-359-2399
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Provider Business Mailing Address
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Address Line | 6099 WATERFORD LN
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City | SORRENTO
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State | LA
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Zip | 70778-3436
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Country | US
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Telephone | 225-390-5161
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10645
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10645
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License Number State | LA
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