Provider Demographics
NPI:1306203104
Name:JOHNSON, CARRIE (LMHC, MSCP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-209 ALALOA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4103
Mailing Address - Country:US
Mailing Address - Phone:808-206-5993
Mailing Address - Fax:
Practice Address - Street 1:1108 FORT STREET MALL STE 10
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2714
Practice Address - Country:US
Practice Address - Phone:808-206-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health