Provider Demographics
NPI:1841657764
Name:JOHNSON, GWANETTE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GWANETTE
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 1:10841 CLASSIQUE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4894
Mailing Address - Country:US
Mailing Address - Phone:225-405-7052
Mailing Address - Fax:
Practice Address - Street 1:2435 DRUSILLA LN
Practice Address - Street 2:SUITE I
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1444
Practice Address - Country:US
Practice Address - Phone:225-405-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional