Provider Demographics
NPI:1164830444
Name:JOHNSON, PHLANDRA (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:PHLANDRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 WATSON BLVD
Mailing Address - Street 2:SUITE 2-345
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8535
Mailing Address - Country:US
Mailing Address - Phone:407-591-0712
Mailing Address - Fax:
Practice Address - Street 1:312 N DAVIS DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3350
Practice Address - Country:US
Practice Address - Phone:478-334-2210
Practice Address - Fax:888-974-3909
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional