Provider Demographics
NPI:1992367940
Name:JOHNSON, LATASHA TAMEKA (LPC)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:TAMEKA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 MCNAIR RD
Mailing Address - Street 2:
Mailing Address - City:ROXIE
Mailing Address - State:MS
Mailing Address - Zip Code:39661-9324
Mailing Address - Country:US
Mailing Address - Phone:404-457-7029
Mailing Address - Fax:
Practice Address - Street 1:9106 MCNAIR RD
Practice Address - Street 2:
Practice Address - City:ROXIE
Practice Address - State:MS
Practice Address - Zip Code:39661-9324
Practice Address - Country:US
Practice Address - Phone:404-457-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007747101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional