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General NPI Number Information
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NPI Number | 1780830596
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Entity Type | Individual
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Provider Name | ELENA ELOISE JOHNSON MA, LCMHC, LCAS
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 2113 BALBOA RD STE 300
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City | RALEIGH
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State | NC
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Zip | 27603-2603
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Country | US
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Telephone | 864-616-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 242 SEQUOYAH WAY
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City | SUNSET
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State | SC
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Zip | 29685-2627
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Country | US
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Telephone | 864-616-3236
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3470-A
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3470
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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 | 9417
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License Number State | NC
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