Provider Demographics
NPI:1730466418
Name:JOHNSON, JIMINE WINDY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JIMINE
Middle Name:WINDY
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 1:2625 BUTTERFIELD RD UNIT 138-S
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1244
Mailing Address - Country:US
Mailing Address - Phone:708-582-1597
Mailing Address - Fax:708-352-1699
Practice Address - Street 1:2625 BUTTERFIELD RD UNIT 138-S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1244
Practice Address - Country:US
Practice Address - Phone:708-582-1597
Practice Address - Fax:708-352-1699
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009681101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional