Provider Demographics
NPI:1407125834
Name:JOHNSON, KEISHA H (LPC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 MOUNT ZION BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2566
Mailing Address - Country:US
Mailing Address - Phone:678-610-4497
Mailing Address - Fax:678-610-0404
Practice Address - Street 1:7130 MOUNT ZION BLVD STE 7
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:678-610-4497
Practice Address - Fax:678-610-0404
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional