Provider Demographics
NPI:1912328840
Name:JOHNSON, KALA
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
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 1:6797 N HIGH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2533
Mailing Address - Country:US
Mailing Address - Phone:614-888-9200
Mailing Address - Fax:614-888-3239
Practice Address - Street 1:6797 N HIGH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:614-888-9200
Practice Address - Fax:614-888-3239
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health