Healthcare Provider Details

I. General information

NPI: 1992141691
Provider Name (Legal Business Name): JENNA LEE JOHNSTON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNMENT CENTER DR STE 200
WILMINGTON NC
28403-1796
US

IV. Provider business mailing address

301 GOVERNMENT CENTER DR STE 200
WILMINGTON NC
28403-1796
US

V. Phone/Fax

Practice location:
  • Phone: 910-877-8180
  • Fax: 910-218-9337
Mailing address:
  • Phone: 910-877-8180
  • Fax: 910-218-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: