Healthcare Provider Details

I. General information

NPI: 1184693368
Provider Name (Legal Business Name): KAREN LEIGH JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 LIBERTY RD NW
ROANOKE VA
24012-4745
US

IV. Provider business mailing address

301 ELM AVE SW
ROANOKE VA
24016-4001
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-1102
  • Fax: 540-344-6149
Mailing address:
  • Phone: 540-345-9841
  • Fax: 540-527-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003356
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: