Provider Demographics
NPI:1043059033
Name:JOHNSON, LAKEISHA JUNA (LMSW)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:JUNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11609 LONE PINE CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-8200
Mailing Address - Country:US
Mailing Address - Phone:317-709-5701
Mailing Address - Fax:
Practice Address - Street 1:3500 DEPAUW BLVD STE 1050
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6125
Practice Address - Country:US
Practice Address - Phone:317-471-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011739A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker