Provider Demographics
NPI:1376829945
Name:JOHNSON, AMY MERCADO (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MERCADO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, LPC, NCC
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 942
Mailing Address - Street 2:568 SOUTH LINCOLN STREET
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0942
Mailing Address - Country:US
Mailing Address - Phone:910-984-4806
Mailing Address - Fax:
Practice Address - Street 1:102 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5533
Practice Address - Country:US
Practice Address - Phone:910-892-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8796101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104912Medicaid