Healthcare Provider Details

I. General information

NPI: 1669115317
Provider Name (Legal Business Name): ERICA RAQUEL JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 VANN RD STE 106
BIRMINGHAM AL
35235-3276
US

IV. Provider business mailing address

3215 TRACE WAY
TRUSSVILLE AL
35173-2334
US

V. Phone/Fax

Practice location:
  • Phone: 205-529-9894
  • Fax: 205-900-8793
Mailing address:
  • Phone: 205-529-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4639
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: