Provider Demographics
NPI:1811584642
Name:JOHNSON, JAIME KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 N LECANTO HWY STE D
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3569
Mailing Address - Country:US
Mailing Address - Phone:843-813-2611
Mailing Address - Fax:
Practice Address - Street 1:3404 N LECANTO HWY
Practice Address - Street 2:SUITE D
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465
Practice Address - Country:US
Practice Address - Phone:843-813-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health