Provider Demographics
NPI:1932892619
Name:JOHNSON, KAITLYN (LMSW, CIT-M)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW, CIT-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-1942
Mailing Address - Country:US
Mailing Address - Phone:501-800-4063
Mailing Address - Fax:
Practice Address - Street 1:10025 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-1942
Practice Address - Country:US
Practice Address - Phone:501-800-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCIT-M-00178101YA0400X
AR12872-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)