Provider Demographics
NPI:1285229971
Name:JOHNSON-PENN, ELNORA (LAPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ELNORA
Middle Name:
Last Name:JOHNSON-PENN
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SPRING DALE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9434
Mailing Address - Country:US
Mailing Address - Phone:770-313-7569
Mailing Address - Fax:
Practice Address - Street 1:3520 PIEDMONT RD NE STE 330
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1552
Practice Address - Country:US
Practice Address - Phone:404-351-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006829101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional