Provider Demographics
NPI:1639543747
Name:LANA JOHNSON LCSW LLC
Entity Type:Organization
Organization Name:LANA JOHNSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-400-5724
Mailing Address - Street 1:10761 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:49099-9191
Mailing Address - Country:US
Mailing Address - Phone:574-400-5724
Mailing Address - Fax:574-293-0019
Practice Address - Street 1:10761 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-9191
Practice Address - Country:US
Practice Address - Phone:574-400-5724
Practice Address - Fax:574-293-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006584A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty