Healthcare Provider Details

I. General information

NPI: 1366016800
Provider Name (Legal Business Name): DESHANDRA FELISHA JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 TOLBERT DR
GREENWOOD SC
29649-6914
US

IV. Provider business mailing address

310 TOLBERT DR
GREENWOOD SC
29649-6914
US

V. Phone/Fax

Practice location:
  • Phone: 864-447-7127
  • Fax:
Mailing address:
  • Phone: 864-447-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12057
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: