Individual
MR. SAMUEL LEE JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC, CCGC
Contact information
Practice address
2439 MANHATTAN BLVD STE 102-4, HARVEY, LA 70058-5473
(504) 261-4976
(504) 766-8457
Mailing address
PO BOX 2637, HARVEY, LA 70059-2637
(504) 261-4976
(504) 766-6792
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1603
LA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
5006
LA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
171000000X
Military Health Care Provider
—
—
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
—
—
225C00000X
Rehabilitation Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
010494439
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461582868
461582868
LA
Enumeration date
10/12/2015
Last updated
01/12/2021
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