Provider Demographics
NPI:1003188921
Name:JOHNSON, LASHANDA TANIESHA (MS MFT)
Entity Type:Individual
Prefix:
First Name:LASHANDA
Middle Name:TANIESHA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LINDSLEY PL
Mailing Address - Street 2:2ND FL
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1109
Mailing Address - Country:US
Mailing Address - Phone:484-554-5175
Mailing Address - Fax:
Practice Address - Street 1:37 LINDSLEY PL
Practice Address - Street 2:2ND FL
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1109
Practice Address - Country:US
Practice Address - Phone:484-554-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3TP11-024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist