Provider Demographics
NPI:1053022566
Name:JOHANSEN, JADE (NCC, M ED)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:NCC, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GOAL MENTALITY, LLC
Mailing Address - Street 2:10375 FORD AVE BUILDING A, SUITE 3
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324
Mailing Address - Country:US
Mailing Address - Phone:912-500-5800
Mailing Address - Fax:
Practice Address - Street 1:GOAL MENTALITY, LLC
Practice Address - Street 2:10375 FORD AVE BUILDING A, SUITE 3
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-500-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health