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NPI Code Detail

MEDICARE: PAMELA JOHNSON M.ED.,PCC-S

MEDICARE: PAMELA JOHNSON M.ED.,PCC-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor110117OH
2101YM0800XMental Health CounselorE2779OH
3101YP2500XProfessional CounselorE2779OH

General Provider Information

NPI Number : 1679711386
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA JOHNSON M.ED.,PCC-S
Provider Business Mailing Address
First Line : PO BOX 226
Second Line :
City : WAVERLY
State : OH
Zip : 45690
Country : US
Telephone Number : 740-981-6513
Fax Number :
Provider Business Practice Location Address
First Line : 218 E NORTH ST
Second Line :
City : WAVERLY
State : OH
Zip : 45690-1148
Country : US
Telephone Number : 740-981-6513
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2009
Last Update Date : 07/21/2022

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Directions to “ PAMELA JOHNSON M.ED.,PCC-S” Practice Location

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