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General NPI Number Information
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NPI Number | 1598264541
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Entity Type | Individual
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Provider Name | MADDIE ELIZABETH JOHNSON MS, LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 444 S WILLOW ST STE 7
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City | EFFINGHAM
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State | IL
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Zip | 62401-3764
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Country | US
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Telephone | 217-347-7384
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 N MERCHANT ST APT 1
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City | EFFINGHAM
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State | IL
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Zip | 62401-2199
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Country | US
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Telephone | 217-821-8084
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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 | 180.011221
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License Number State | IL
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