MEDICARE: MRS. AMY DALE MERCADO JOHNSON M.ED., LPC, NCC

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	101YP2500X	Professional Counselor	8796	NC
2	101YM0800X	Mental Health Counselor	8796	NC
3	101YM0800X	Mental Health Counselor	QS142206	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376829945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY DALE MERCADO JOHNSON M.ED., LPC, NCC

Provider Business Mailing Address
First Line	:	711 EXECUTIVE PL FL 3
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 EXECUTIVE PL FL 3
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5193
Country	:	US
Telephone Number	:	910-615-3750
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	02/04/2026

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