Provider Demographics
NPI:1619425279
Name:JOHNSON, SHITONDA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:SHITONDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14416
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77221-4416
Mailing Address - Country:US
Mailing Address - Phone:713-425-6412
Mailing Address - Fax:
Practice Address - Street 1:10303 NORTHWEST FWY STE 318
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8221
Practice Address - Country:US
Practice Address - Phone:713-425-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034271041C0700X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical