Provider Demographics
NPI:1891424578
Name:JOHNSON, LATOYA (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 W KIEHNAU AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3024
Mailing Address - Country:US
Mailing Address - Phone:414-350-9139
Mailing Address - Fax:
Practice Address - Street 1:4113 W KIEHNAU AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3024
Practice Address - Country:US
Practice Address - Phone:414-350-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)