Provider Demographics
NPI:1265822662
Name:JOHNSON, CECELIA DELPHINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:DELPHINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36610-4325
Mailing Address - Country:US
Mailing Address - Phone:251-751-2812
Mailing Address - Fax:
Practice Address - Street 1:1111 W CLARK AVE
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-4325
Practice Address - Country:US
Practice Address - Phone:251-751-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL245101YM0800X
MST0374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health