Marquetta Johnson, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

10492-C Issued in AR

Practice address

205 Ingram Blvd
West Memphis, AR 72301-3423

Phone

(870) 739-6818

Fax

(870) 662-6826

NPI assigned

Sep 29, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids for the Future, Inc.

  • Clinical Child & Adolescent Psychologist
  • West Memphis, AR
  • NPI 1770719106
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1740904176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 MADISON AVE # 2153",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042620",
            "telephone_number": "901-201-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 INGRAM BLVD",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013423",
            "telephone_number": "870-739-6818",
            "fax_number": "870-662-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARQUETTA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-29",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "10492-C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "9285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Johnson, MHPP
• Elisabeth L Johnson
• Felica Shunta Johnson
• Jessica Johnson, RN
• Linda K Johnson, MHPP
• Mary Johnson
• Nathaniel Johnson
• Paulette Johnson, FNP-C
• Stacey Johnson, OT
• Taylor N Johnson

• Social Worker in West Memphis, AR
• Providers in West Memphis, AR by specialty
• Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.