Provider Demographics
NPI:1528552536
Name:JOHNSON, JAMEELAH L (LCDC III)
Entity Type:Individual
Prefix:
First Name:JAMEELAH
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6771
Mailing Address - Country:US
Mailing Address - Phone:216-561-8300
Mailing Address - Fax:216-561-8301
Practice Address - Street 1:4002 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6771
Practice Address - Country:US
Practice Address - Phone:216-561-8300
Practice Address - Fax:216-561-8301
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162648101YA0400X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health