Basic Information
| Provider Information | |||||||||
| NPI: | 1699018309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | CIERRA | ||||||||
| MiddleName: | CHANTELL | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 DARALYN DR | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703638071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858707590 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8326 MAIN ST BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858682620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 12582 | LA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | 12582 | LA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.