Healthcare Provider Details

I. General information

NPI: 1508772229
Provider Name (Legal Business Name): LUCY JOHNSON LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1180 COLUMBIA AVE
IRMO SC
29063-2890
US

IV. Provider business mailing address

716 ZIMALCREST DR APT 2814
COLUMBIA SC
29210-6585
US

V. Phone/Fax

Practice location:
  • Phone: 803-407-0088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9087
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: