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General NPI Number Information
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NPI Number | 1851913826
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Entity Type | Individual
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Provider Name | DIRENE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 396 NORTH MAIN STREET
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City | SIBLEY
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State | LA
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Zip | 71073
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Country | US
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Telephone | 318-947-9084
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 134
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City | SIBLEY
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State | LA
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Zip | 71073-0134
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Country | US
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Telephone | 346-857-9164
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9035
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License Number State | LA
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