Provider Demographics
NPI:1184769150
Name:JOHNSON, ANNIE F
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:F
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 1:104 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5004
Mailing Address - Country:US
Mailing Address - Phone:337-262-5565
Mailing Address - Fax:
Practice Address - Street 1:302 DULLES DRIVE
Practice Address - Street 2:CRISIS AND REFERRAL
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5004
Practice Address - Country:US
Practice Address - Phone:337-262-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor