Provider Demographics
NPI:1679088355
Name:JOHNSON, TAKANDRA A (LCSW)
Entity type:Individual
Prefix:
First Name:TAKANDRA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MILLICENT WAY APT 605
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2254
Mailing Address - Country:US
Mailing Address - Phone:337-351-1561
Mailing Address - Fax:
Practice Address - Street 1:2525 ONEAL LN APT 305
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3412
Practice Address - Country:US
Practice Address - Phone:337-351-1561
Practice Address - Fax:337-351-1561
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA122891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical