Doctor Name: | KATINA R JOHNSON-PEASE |
NPI Number: | 1013289990 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LAPC |
License Number: | APC002573 |
Business Practice Address: | 3914 Maple Tree Ln Loganville, GA - 300528705 |
Business Phone Number: | 6685338787 |
Business Fax Number: | |
Mailing Address: | 3914 Maple Tree Ln, LOGANVILLE |
State: | GA |
Postal Code: | 300528705 |
Phone Number: | 6685338787 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2012 |
NPI Last Update Date: | 02/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | APC002573 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |