Provider Demographics
NPI:1225333420
Name:JOHNSON, MARTHA JOSEPH (LPC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JOSEPH
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 1:2211 BILLY ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-9147
Mailing Address - Country:US
Mailing Address - Phone:704-425-3153
Mailing Address - Fax:
Practice Address - Street 1:2211 BILLY ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-9147
Practice Address - Country:US
Practice Address - Phone:704-425-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7955101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor