Healthcare Provider Details

I. General information

NPI: 1104314459
Provider Name (Legal Business Name): ALLANA DIANNE JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 WOODSIDE EXECUTIVE CT
AIKEN SC
29803-3820
US

IV. Provider business mailing address

881 WILLOW LK
EVANS GA
30809-8031
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0190
  • Fax: 803-226-0258
Mailing address:
  • Phone: 706-414-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6832
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: