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General NPI Number Information
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NPI Number | 1114363140
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Entity Type | Individual
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Provider Name | CAROL MARTIN JOHNSON MA, ATR-BC, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4919 PENTRIDGE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-3320
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Country | US
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Telephone | 267-608-5354
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Fax | 610-387-6056
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Provider Business Mailing Address
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Address Line | 4900 SPRUCE ST UNIT 502
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City | PHILADELPHIA
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State | PA
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Zip | 19139-4372
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Country | US
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Telephone | 267-608-5354
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004304
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License Number State | PA
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