Provider Demographics
NPI:1497466247
Name:JOHNSON, ANNA (LAC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 WILSON FARM RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-8200
Mailing Address - Country:US
Mailing Address - Phone:501-557-6785
Mailing Address - Fax:501-613-0411
Practice Address - Street 1:8 WILSON FARM RD STE D
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-8200
Practice Address - Country:US
Practice Address - Phone:501-557-6785
Practice Address - Fax:501-613-0411
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF2302001106H00000X
ARA2210022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist