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General NPI Number Information
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NPI Number | 1356634141
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Entity Type | Individual
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Provider Name | RACHEL MARIE JOHNSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 311 E MAIN ST ST. 205
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City | GALESBURG
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State | IL
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Zip | 61401-4855
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Country | US
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Telephone | 224-532-1336
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Fax |
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Provider Business Mailing Address
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Address Line | 2299 CHRISTOPHER DR
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City | GALESBURG
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State | IL
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Zip | 61401-1410
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Country | US
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Telephone | 224-532-1336
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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 | 180007469
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License Number State | IL
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