Provider Demographics
NPI:1205188083
Name:JOHNSON, ADDIE (LPC)
Entity Type:Individual
Prefix:
First Name:ADDIE
Middle Name:
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 1:1811 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 214-215
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1111
Mailing Address - Country:US
Mailing Address - Phone:215-643-0200
Mailing Address - Fax:215-643-9844
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 214-215
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:215-643-0200
Practice Address - Fax:215-643-9844
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC32681041C0700X
PAPC 007726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid
PA12751349OtherCAQH