Provider Demographics
NPI:1023366341
Name:JOHNSON, CARLA J (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:J
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 1:121 STEEPLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1050
Mailing Address - Country:US
Mailing Address - Phone:912-660-9117
Mailing Address - Fax:
Practice Address - Street 1:7373 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE #B6-1
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1503
Practice Address - Country:US
Practice Address - Phone:912-660-9117
Practice Address - Fax:912-920-0100
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC006066OtherGEORGIA COMPOSITE BOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS, AND THERAPIS