MEDICARE: KIMBERLY JOHNSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC004612	GA

General Provider Information

NPI Number	:	1013073329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JOHNSON LPC

Provider Business Mailing Address
First Line	:	1401 BURLEYSON DR STE 1
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2522
Country	:	US
Telephone Number	:	706-270-5002
Fax Number	:	706-240-5111

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 206
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2654
Country	:	US
Telephone Number	:	678-567-0920
Fax Number	:	678-567-0950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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Directions to “ KIMBERLY JOHNSON LPC” Practice Location

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