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General NPI Number Information
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NPI Number | 1760969455
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Entity Type | Individual
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Provider Name | MARQUETTA L JOHNSON LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 1525 CUBA RD
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City | MAYFIELD
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State | KY
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Zip | 42066-6809
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Country | US
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Telephone | 270-247-2588
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Fax | 270-247-0142
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Provider Business Mailing Address
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Address Line | 1525 CUBA RD
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City | MAYFIELD
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State | KY
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Zip | 42066-6809
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Country | US
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Telephone | 270-247-2588
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Fax | 270-247-0142
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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 | 261479
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 261479
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License Number State | KY
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