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General NPI Number Information
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NPI Number | 1740658376
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Entity Type | Individual
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Provider Name | CHARRYSE JOHNSON MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 5970 FAIRVIEW RD STE 420
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City | CHARLOTTE
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State | NC
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Zip | 28210-3167
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Country | US
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Telephone | 980-236-1511
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Fax | 704-919-5460
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Provider Business Mailing Address
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Address Line | 5970 FAIRVIEW RD STE 420
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City | CHARLOTTE
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State | NC
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Zip | 28210-3167
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Country | US
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Telephone | 980-701-4192
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Fax | 980-701-4194
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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 | 11709
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11709
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11709
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License Number State | NC
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