Provider Demographics
NPI:1821591389
Name:JOHNSON, RACQUEL
Entity Type:Individual
Prefix:MRS
First Name:RACQUEL
Middle Name:
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 1:552 DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2860
Mailing Address - Country:US
Mailing Address - Phone:504-259-0274
Mailing Address - Fax:
Practice Address - Street 1:1901 WESTBANK EXPY STE 550
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4362
Practice Address - Country:US
Practice Address - Phone:504-259-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker