Provider Demographics
NPI:1326314667
Name:JOHNSON, PAMELA DESHAWN (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DESHAWN
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 1:1021 CHURCH ST SE APT D1
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3559
Mailing Address - Country:US
Mailing Address - Phone:404-832-5339
Mailing Address - Fax:678-802-3156
Practice Address - Street 1:1021 CHURCH ST SE APT D1
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3559
Practice Address - Country:US
Practice Address - Phone:404-832-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCC 259849101Y00000X
GA007455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor