Healthcare Provider Details

I. General information

NPI: 1902375165
Provider Name (Legal Business Name): DENISE CAMPOS JOHNSON LCMHC, LCAS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HUNTING LODGE DR
BLACK MOUNTAIN NC
28711-9799
US

IV. Provider business mailing address

105 W STATE ST
BLACK MOUNTAIN NC
28711-3418
US

V. Phone/Fax

Practice location:
  • Phone: 305-834-2014
  • Fax:
Mailing address:
  • Phone: 828-585-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA13706
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24073
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8360
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: