Provider Demographics
NPI:1609217090
Name:JOHNSON MANNEH, MARQUITA RENEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:RENEE
Last Name:JOHNSON MANNEH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:JOHNSON
Other - Last Name:MANNEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:7419 KNIGHTDALE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7419 KNIGHTDALE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8825
Practice Address - Country:US
Practice Address - Phone:919-891-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-13
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094521041C0700X
NCP0079331041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker