Provider Demographics
NPI:1295201663
Name:JOHNSON, VALLENTHIA ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:VALLENTHIA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W DAVIDSON AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4945
Mailing Address - Country:US
Mailing Address - Phone:208-640-6503
Mailing Address - Fax:
Practice Address - Street 1:2195 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2624
Practice Address - Country:US
Practice Address - Phone:208-769-1406
Practice Address - Fax:208-769-1430
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-37825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker