Healthcare Provider Details

I. General information

NPI: 1821438797
Provider Name (Legal Business Name): BEVERLY L JOHNSON MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2676 SILVER WEED CT
WINNABOW NC
28479-6501
US

IV. Provider business mailing address

2676 SILVER WEED CT
WINNABOW NC
28479-6501
US

V. Phone/Fax

Practice location:
  • Phone: 919-368-2058
  • Fax:
Mailing address:
  • Phone: 919-368-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011178
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: