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NPI Code Detail

MEDICARE: MRS. GWANETTE JOHNSON LPC

MEDICARE: MRS. GWANETTE JOHNSON LPC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor3544LA

General Provider Information

NPI Number : 1841657764
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GWANETTE JOHNSON LPC
Provider Business Mailing Address
First Line : 10841 CLASSIQUE DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70815-4894
Country : US
Telephone Number : 225-405-7052
Fax Number :
Provider Business Practice Location Address
First Line : 2435 DRUSILLA LN
Second Line : SUITE I
City : BATON ROUGE
State : LA
Zip : 70809-1444
Country : US
Telephone Number : 225-405-7052
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2016
Last Update Date : 03/28/2016

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