Provider Demographics
NPI:1184978561
Name:JOHNSON, VIVECA (LPC)
Entity type:Individual
Prefix:
First Name:VIVECA
Middle Name:
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 1:2435 DRUSILLA LN STE F
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1444
Mailing Address - Country:US
Mailing Address - Phone:225-508-3253
Mailing Address - Fax:225-647-3167
Practice Address - Street 1:2435 DRUSILLA LN STE F
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1444
Practice Address - Country:US
Practice Address - Phone:225-508-3253
Practice Address - Fax:225-647-3167
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional