Provider Demographics
NPI:1003105321
Name:JOHNSON, MONIQUE S (LPC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4913
Mailing Address - Country:US
Mailing Address - Phone:205-510-2600
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:1401 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4913
Practice Address - Country:US
Practice Address - Phone:205-510-2600
Practice Address - Fax:205-510-2790
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALLPC2OtherAMERICAN BEHAVIORAL HEALTH