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General NPI Number Information
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NPI Number | 1861969735
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Entity Type | Individual
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Provider Name | KAMIQUE MICHELLE JOHNSON MHP, PHD
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Gender | Female
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 609 REDWATER RD.
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City | WAKE VILLAGE
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State | TX
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Zip | 75501-7550
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Country | US
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Telephone | 903-501-8032
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Fax | 903-582-7338
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Provider Business Mailing Address
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Address Line | 2927 KING OAKS LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71107-4224
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Country | US
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Telephone | 318-780-2828
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Fax | 866-343-8862
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | LA
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