Healthcare Provider Details

I. General information

NPI: 1710612189
Provider Name (Legal Business Name): REBECCA JOHNSON LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHILOH RD NW STE 1240
KENNESAW GA
30144-7163
US

IV. Provider business mailing address

1301 SHILOH RD NW STE 1240
KENNESAW GA
30144-7163
US

V. Phone/Fax

Practice location:
  • Phone: 240-780-6628
  • Fax:
Mailing address:
  • Phone: 240-780-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015189
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: