Provider Demographics
NPI:1134436520
Name:JOHNSON, QUINESSA SHONTE (PHD)
Entity type:Individual
Prefix:DR
First Name:QUINESSA
Middle Name:SHONTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 INTERSTATE 30
Mailing Address - Street 2:224
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7489
Mailing Address - Country:US
Mailing Address - Phone:214-497-5673
Mailing Address - Fax:
Practice Address - Street 1:105 KATHRYN DR
Practice Address - Street 2:STE 800
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:214-497-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional