Provider Demographics
NPI:1942013446
Name:JOHNSON, KINIJA LENAE SHANELLE
Entity type:Individual
Prefix:
First Name:KINIJA
Middle Name:LENAE SHANELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19540 EUCLID AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1431
Mailing Address - Country:US
Mailing Address - Phone:216-758-0743
Mailing Address - Fax:
Practice Address - Street 1:19540 EUCLID AVE APT 201
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1431
Practice Address - Country:US
Practice Address - Phone:216-758-0743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)