Provider Demographics
NPI:1376844472
Name:JOHNSON, VANESIA REGINA (LCSW)
Entity Type:Individual
Prefix:
First Name:VANESIA
Middle Name:REGINA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2234
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2234
Mailing Address - Country:US
Mailing Address - Phone:713-530-8372
Mailing Address - Fax:
Practice Address - Street 1:16106 DAWN MARIE LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7523
Practice Address - Country:US
Practice Address - Phone:832-429-6965
Practice Address - Fax:281-809-4596
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37114104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker