MEDICARE: MRS. SANDY MICHELLE JOHNSON M.S. LPC, NCC, CCTP

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	6595	SC

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	:	1982017059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDY MICHELLE JOHNSON M.S. LPC, NCC, CCTP

Provider Business Mailing Address
First Line	:	1293 PROFESSIONAL DR STE A101
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	843-213-1307
Fax Number	:	843-962-5570

Provider Business Practice Location Address
First Line	:	1293 PROFESSIONAL DR STE A-101
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5754
Country	:	US
Telephone Number	:	843-605-0514
Fax Number	:	843-962-5570

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

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	06/18/2022

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