Healthcare Provider Details

I. General information

NPI: 1609844497
Provider Name (Legal Business Name): CHERYL JANE JOHNSON MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 CARMEL EXECUTIVE PARK DR SUITE 210
CHARLOTTE NC
28226-8275
US

IV. Provider business mailing address

3504 ABBEY HILL LN
CHARLOTTE NC
28210-1913
US

V. Phone/Fax

Practice location:
  • Phone: 704-752-8414
  • Fax:
Mailing address:
  • Phone: 704-540-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number994
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: