Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LPC.0014267 | CO |
NPI | 1003203019 |
---|---|
Provider Name | Erica Lynn Johnson |
First Address | Lakewood, CO 80228-1831 |
Second Address | Lakewood, CO 80228-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 28/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000167752 | (05) | CO |