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General NPI Number Information
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NPI Number | 1487051678
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Entity Type | Individual
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Provider Name | LAKEISHA JOHNSON-ELMORE LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 5565 KINGS RETREAT DR E
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City | HORN LAKE
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State | MS
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Zip | 38637-7010
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Country | US
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Telephone | 662-897-8940
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Fax |
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Provider Business Mailing Address
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Address Line | 5565 KINGS RETREAT DR E
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City | HORN LAKE
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State | MS
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Zip | 38637-7010
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Country | US
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Telephone | 662-897-8940
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7551-C
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License Number State | AR
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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 | C8311
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW0000007453
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License Number State | TN
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