Individual
DOMINIQUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
809 POLK ST, MANSFIELD, LA 71052-2452
(318) 871-5566
(318) 871-1076
Mailing address
PO BOX 828, MANSFIELD, LA 71052-0828
(318) 871-5566
(318) 871-1076
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/14/2016
Last updated
08/29/2019
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