Provider Demographics
NPI:1275089930
Name:JOHNSON, SUSAN RENEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RENEE
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:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421-1330
Mailing Address - Country:US
Mailing Address - Phone:757-665-1260
Mailing Address - Fax:757-665-4184
Practice Address - Street 1:19056 GREENBUSH ROAD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-1260
Practice Address - Fax:757-665-4184
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health