Provider Demographics
NPI:1558877688
Name:JOHNSON, PORSCHIA (LCPC)
Entity Type:Individual
Prefix:
First Name:PORSCHIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 RUFE SNOW DR STE 2801008
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3349
Mailing Address - Country:US
Mailing Address - Phone:224-432-0175
Mailing Address - Fax:
Practice Address - Street 1:6245 RUFE SNOW DR STE 2801008
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76148-3349
Practice Address - Country:US
Practice Address - Phone:224-432-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013573101YP2500X
IL180013557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180013557OtherLCPC