Provider Demographics
NPI:1619278884
Name:JOHNSON, KRISTINA CHERIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CHERIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:CHERIE
Other - Last Name:GOUGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:22212 CHIPPEWA LN
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-8046
Mailing Address - Country:US
Mailing Address - Phone:303-946-5003
Mailing Address - Fax:303-557-6240
Practice Address - Street 1:22212 CHIPPEWA LN
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-8046
Practice Address - Country:US
Practice Address - Phone:303-946-5003
Practice Address - Fax:303-557-6240
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical