Provider Demographics
NPI:1912639287
Name:JOHNSON, JAKEIA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JAKEIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JAKEIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4449 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-2843
Mailing Address - Country:US
Mailing Address - Phone:205-527-3503
Mailing Address - Fax:
Practice Address - Street 1:85 BAGBY DR STE 336
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-3717
Practice Address - Country:US
Practice Address - Phone:205-545-0874
Practice Address - Fax:205-377-7762
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4626C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical