MEDICARE: MRS. CHANTELLE M. JOHNSON MA, LPC

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
1	101YM0800X	Mental Health Counselor	LC9388	MD
2	101YM0800X	Mental Health Counselor	0701008174	NC
3	101YM0800X	Mental Health Counselor	S7710	NC
4	101YP2500X	Professional Counselor	LC9388	MD
5	101YM0800X	Mental Health Counselor	7710	NC
6	101YP2500X	Professional Counselor	0701008174	VA
7	101YP2500X	Professional Counselor	7710	NC
8	101YP2500X	Professional Counselor	S7710	NC

General Provider Information

NPI Number	:	1841520590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANTELLE M. JOHNSON MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 8936
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-6936
Country	:	US
Telephone Number	:	980-613-8312
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 EXECUTIVE CENTER DR STE 215
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-8823
Country	:	US
Telephone Number	:	980-613-8312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2009
Last Update Date	:	06/30/2025

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Directions to “ MRS. CHANTELLE M. JOHNSON MA, LPC” Practice Location

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