Individual
CHERYLE DEVETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1434 HAWN AVE STE 12, SHREVEPORT, LA 71107
(318) 675-0224
Mailing address
1434 HAWN AVE STE 12, SHREVEPORT, LA 71107-6508
(318) 675-0224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5688
LA
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
000024113
LA
Other
Enumeration date
09/12/2017
Last updated
09/01/2023
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