MEDICARE: MR. MILES CARLISLE JOHNSON MS, 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	101YP2500X	Professional Counselor	8025	SC

General Provider Information

NPI Number	:	1750977435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MILES CARLISLE JOHNSON MS, LPC

Provider Business Mailing Address
First Line	:	508 SANDPINE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7629
Country	:	US
Telephone Number	:	803-463-9818
Fax Number	:

Provider Business Practice Location Address
First Line	:	418A BARR RD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2363
Country	:	US
Telephone Number	:	864-280-7208
Fax Number	:	803-621-9061

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

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	09/24/2024

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