Healthcare Provider Details

I. General information

NPI: 1184830465
Provider Name (Legal Business Name): KERRIE LYNN JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 PINEDALE RD STE B
GREENSBORO NC
27408-2018
US

IV. Provider business mailing address

204 E. VANDALIA RD.
GREENSBORO NC
27406-5904
US

V. Phone/Fax

Practice location:
  • Phone: 336-880-3112
  • Fax:
Mailing address:
  • Phone: 336-880-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4934
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: