MEDICARE: MS. JEFKIDA LASHA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	AL
2	101YM0800X	Mental Health Counselor	AL
3	101YM0800X	Mental Health Counselor	GA
4	103TC1900X	Counseling Psychologist	FL
5	106H00000X	Marriage & Family Therapist	GA
6	106H00000X	Marriage & Family Therapist	AL
7	101YM0800X	Mental Health Counselor	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639690381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEFKIDA LASHA JOHNSON

Provider Business Mailing Address
First Line	:	7007 POTSDAM CT
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8028
Country	:	US
Telephone Number	:	334-320-0084
Fax Number	:	888-856-7677

Provider Business Practice Location Address
First Line	:	320 1ST ST N STE 612
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6947
Country	:	US
Telephone Number	:	334-647-1009
Fax Number	:	888-856-7677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	04/26/2022

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Directions to “ MS. JEFKIDA LASHA JOHNSON ” Practice Location

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