Healthcare Provider Details

I. General information

NPI: 1578486213
Provider Name (Legal Business Name): JENNIFER LEIGH JOHNSON AADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 NEW HOPE RD STE 201
PRINCETON WV
24740-2271
US

IV. Provider business mailing address

162 WOODCHUCK RD
PRINCETON WV
24739-7791
US

V. Phone/Fax

Practice location:
  • Phone: 304-913-4166
  • Fax:
Mailing address:
  • Phone: 304-913-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: