Provider Demographics
NPI:1083991152
Name:JOHNSON, ARTHUR JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BALL POWELL ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6652
Mailing Address - Country:US
Mailing Address - Phone:313-790-5725
Mailing Address - Fax:
Practice Address - Street 1:70 BALL POWELL ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-6652
Practice Address - Country:US
Practice Address - Phone:313-790-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA760101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)