Healthcare Provider Details

I. General information

NPI: 1649788316
Provider Name (Legal Business Name): JOHNSON COUNSELING AND FAMILY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N CENTRAL AVE
LANDIS NC
28088-1445
US

IV. Provider business mailing address

112 N CENTRAL AVE
LANDIS NC
28088-1445
US

V. Phone/Fax

Practice location:
  • Phone: 704-741-0456
  • Fax: 704-270-6223
Mailing address:
  • Phone: 704-741-0456
  • Fax: 704-270-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7955
License Number StateNC

VIII. Authorized Official

Name: MARTHA JOSEPH JOHNSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 704-425-3153