Provider Demographics
NPI:1558815076
Name:JOHNSON, RESNEE
Entity Type:Individual
Prefix:
First Name:RESNEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S MARIETTA PKWY SE STE B
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2800
Mailing Address - Country:US
Mailing Address - Phone:678-448-7191
Mailing Address - Fax:678-712-5053
Practice Address - Street 1:1111 S MARIETTA PKWY SE STE B
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2800
Practice Address - Country:US
Practice Address - Phone:678-448-7191
Practice Address - Fax:678-712-5053
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional