Johnson, Kennitra Marie

Johnson, Kennitra Marie is an individual health care provider with primary practice located at 524 S Burnside Ave , Gonzales LA 70737-3448. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Case Manager/Care Coordinator, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Johnson, Kennitra Marie can be contacted via phone (225) 257-4677.

Contact Information

Primary practice address
524 S Burnside Ave Gonzales LA 70737-3448
Phone: (225) 257-4677
Fax: (225) 257-4678
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X 10645 Louisiana
Behavioral Health & Social Service Providers / Social Worker 104100000X 10645 Louisiana

Profile Details

NPI number 1447994090
LBN Legal business name Johnson, Kennitra Marie
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2022
Last updated Dec 12th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447994090 NPPES
Louisiana MEDICAID 00000000

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