Doctor Name: | AMANDA JOHNSON |
NPI Number: | 1215397922 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 4242 Highway 19 Suite 3b Zachary, LA - 707913981 |
Business Phone Number: | 2257575699 |
Business Fax Number: | |
Mailing Address: | 1713 General Mouton Ave, BATON ROUGE |
State: | LA |
Postal Code: | 708106818 |
Phone Number: | 2252873791 |
Fax Number: | |
NPI Enumeration Date: | 02/24/2016 |
NPI Last Update Date: | 02/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |