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General NPI Number Information
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NPI Number | 1053783480
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Entity Type | Individual
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Provider Name | KATHARINE JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2015
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 6952 DOGWOOD MNR N STE 101
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2091
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Country | US
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Telephone | 662-782-6652
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Fax |
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Provider Business Mailing Address
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Address Line | 4828 ANTEBELLUM LN
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-6575
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Country | US
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Telephone | 256-682-9230
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3466
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2413
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License Number State | MS
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