=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679824569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVIS C JOHNSON LCMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 05/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 MINTURN AVE
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-461-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 MINTURN AVE
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-2137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-461-9097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 9416
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------