Provider Demographics
NPI:1104389550
Name:JOHNSON, ERIKA LANE (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:LANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2237
Mailing Address - Country:US
Mailing Address - Phone:701-297-7540
Mailing Address - Fax:
Practice Address - Street 1:1020 36TH ST SW
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2237
Practice Address - Country:US
Practice Address - Phone:701-297-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND999-3-15-19A101YM0800X
ND999-3-15-19-417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty