Healthcare Provider Details

I. General information

NPI: 1679381834
Provider Name (Legal Business Name): STEPHANIE DAWN JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 EISENHOWER PKWY
MACON GA
31206-0800
US

IV. Provider business mailing address

3780 EISENHOWER PKWY
MACON GA
31206-0800
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5500
  • Fax: 478-784-5496
Mailing address:
  • Phone: 478-633-5500
  • Fax: 478-784-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number009640
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number009640
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: