Individual
LACI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.ED.
Contact information
Practice address
8113 LIMA RD STE B, FORT WAYNE, IN 46818-2162
(260) 267-5175
Mailing address
7323 THOROUGHBRED DR APT 3D, FORT WAYNE, IN 46804-2350
(260) 271-9081
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
99125292A
IN
Other
Enumeration date
06/06/2024
Last updated
06/11/2024
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