Healthcare Provider Details

I. General information

NPI: 1831933001
Provider Name (Legal Business Name): ESSENCE CIARA JOHNSON LPC-IT, CRC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 SEMINOLE CENTRE CT STE 210
FITCHBURG WI
53711-5019
US

IV. Provider business mailing address

5944 SEMINOLE CENTRE CT STE 210
FITCHBURG WI
53711-5019
US

V. Phone/Fax

Practice location:
  • Phone: 844-467-3467
  • Fax: 844-502-1200
Mailing address:
  • Phone: 844-467-3467
  • Fax: 844-502-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8928
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: