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General NPI Number Information
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NPI Number | 1023699147
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Entity Type | Individual
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Provider Name | ANDREW JOHNSON LPC
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Gender | Male
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 416 GEORGE ST STE B12
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City | DE PERE
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State | WI
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Zip | 54115-2777
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Country | US
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Telephone | 920-340-0939
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Fax |
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Provider Business Mailing Address
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Address Line | 416 GEORGE ST STE B12
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City | DE PERE
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State | WI
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Zip | 54115-2777
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Country | US
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Telephone | 920-340-0939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20162-130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5526-125
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License Number State | WI
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