Provider Demographics
NPI:1184883886
Name:BENTON-JOHNSON, JIKESHA RENEE (PSYD)
Entity type:Individual
Prefix:
First Name:JIKESHA
Middle Name:RENEE
Last Name:BENTON-JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 COLONIAL CENTER PARKWAY
Mailing Address - Street 2:SUITE 100N
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-9328
Mailing Address - Country:US
Mailing Address - Phone:404-317-1034
Mailing Address - Fax:
Practice Address - Street 1:3625 N ELM ST STE 130
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2604
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003410103TC0700X
NC6600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical