Healthcare Provider Details

I. General information

NPI: 1992630883
Provider Name (Legal Business Name): TRUTH DIVINE JOHNSON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 BANKING ST # 29525
GREENSBORO NC
27408-7222
US

IV. Provider business mailing address

5708 WILDBERRY DR
GREENSBORO NC
27409-2716
US

V. Phone/Fax

Practice location:
  • Phone: 336-530-9006
  • Fax:
Mailing address:
  • Phone: 704-670-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23067
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: