Provider Demographics
NPI:1174793764
Name:JOHNSON, SARITA (LCPC)
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 LAKE COOK RD
Mailing Address - Street 2:SUITE 207E
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5617
Mailing Address - Country:US
Mailing Address - Phone:847-205-9760
Mailing Address - Fax:847-205-9780
Practice Address - Street 1:747 LAKE COOK RD
Practice Address - Street 2:SUITE 207E
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5617
Practice Address - Country:US
Practice Address - Phone:847-205-9760
Practice Address - Fax:847-205-9780
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health