Healthcare Provider Details

I. General information

NPI: 1033595426
Provider Name (Legal Business Name): JOHANNAH ROBINETTE LCMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 HOMESTEAD RD
HARMONY NC
28634-9448
US

IV. Provider business mailing address

PO BOX 158
UNION GROVE NC
28689-0158
US

V. Phone/Fax

Practice location:
  • Phone: 704-928-7360
  • Fax: 704-919-5731
Mailing address:
  • Phone: 704-928-7360
  • Fax: 704-919-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11727
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11727
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: