Provider Demographics
NPI:1386207298
Name:JOHNSON, ERICA DENA (LT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:DENA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 MAYWEATHER LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2329
Mailing Address - Country:US
Mailing Address - Phone:346-325-3002
Mailing Address - Fax:
Practice Address - Street 1:11810 HAMMOND DR APT 606
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3866
Practice Address - Country:US
Practice Address - Phone:346-244-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility