Healthcare Provider Details

I. General information

NPI: 1912631706
Provider Name (Legal Business Name): ENCOUNTER COMMUNITY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W GOVERNMENT STREET, BUILDING B. SUITE 214
BRANDON MS
39042-2423
US

IV. Provider business mailing address

1700 W GOVERNMENT STREET, BUILDING B. SUITE 214
BRANDON MS
39042-2423
US

V. Phone/Fax

Practice location:
  • Phone: 601-613-1240
  • Fax:
Mailing address:
  • Phone: 601-613-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN KEITH JOHNSON JR.
Title or Position: OWNER/THERAPIST
Credential: DPC, LPC-S, CADC II
Phone: 601-613-1240