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General NPI Number Information
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NPI Number | 1497599054
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Entity Type | Individual
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Provider Name | SHAHEEDRA AVEONNE JOHNSON M.S., LPC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 4040 N CENTRAL EXPY STE 670
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City | DALLAS
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State | TX
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Zip | 75204-3158
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Country | US
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Telephone | 469-290-4285
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 JADE FOREST LN
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City | MESQUITE
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State | TX
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Zip | 75181-4310
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Country | US
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Telephone | 469-290-4285
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 90422
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License Number State | TX
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