Healthcare Provider Details

I. General information

NPI: 1538449442
Provider Name (Legal Business Name): RAYMOND BLAIR JOHNSON III LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

IV. Provider business mailing address

5050 MADISON RD
CINCINNATI OH
45227-1491
US

V. Phone/Fax

Practice location:
  • Phone: 513-272-2800
  • Fax: 513-631-7484
Mailing address:
  • Phone: 513-272-2800
  • Fax: 513-631-7484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1100057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: