Provider Demographics
NPI:1093390569
Name:JOHNSON, ASHLEY (APC, NCC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 PACES STATION RDG
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4074
Mailing Address - Country:US
Mailing Address - Phone:770-820-8075
Mailing Address - Fax:
Practice Address - Street 1:1900 THE EXCHANGE SE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2022
Practice Address - Country:US
Practice Address - Phone:678-842-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty