Provider Demographics
NPI:1508345034
Name:JOHNSON, SHATIRIA MONIQUE (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHATIRIA
Middle Name:MONIQUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1223
Mailing Address - Country:US
Mailing Address - Phone:305-205-7916
Mailing Address - Fax:
Practice Address - Street 1:2125 BISCAYNE BLVD # 275
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5031
Practice Address - Country:US
Practice Address - Phone:786-910-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health