Provider Demographics
NPI:1831647015
Name:JOHNSON, WILLIE LENEIL (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:LENEIL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2132
Mailing Address - Country:US
Mailing Address - Phone:773-266-8234
Mailing Address - Fax:773-952-8868
Practice Address - Street 1:5914 S GREEN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2132
Practice Address - Country:US
Practice Address - Phone:773-266-8234
Practice Address - Fax:773-952-8868
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL291616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional