Individual
KENNITRA MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
576 BELLE TERRE BLVD, LA PLACE, LA 70068-1715
(504) 493-2271
(985) 359-2399
Mailing address
6099 WATERFORD LN, SORRENTO, LA 70778-3436
(225) 390-5161
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10645
LA
1041C0700X
Clinical Social Worker
Primary
10645
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
LA
Enumeration date
04/20/2022
Last updated
09/04/2024
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