Provider Demographics
NPI:1679053011
Name:JOHNSON, KANISHA NATHASHA (MA)
Entity type:Individual
Prefix:MRS
First Name:KANISHA
Middle Name:NATHASHA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:KANISHA
Other - Middle Name:NATHASHA
Other - Last Name:ALLEYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:264 KINGS CV
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3904
Mailing Address - Country:US
Mailing Address - Phone:347-205-7479
Mailing Address - Fax:
Practice Address - Street 1:2000 PARK ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2011
Practice Address - Country:US
Practice Address - Phone:803-386-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC9956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health