Provider Demographics
NPI:1407224082
Name:JOHNSON, SUSAN LEA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEA
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 1:501 GRANDSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6929
Mailing Address - Country:US
Mailing Address - Phone:412-979-1520
Mailing Address - Fax:
Practice Address - Street 1:2009 MACKENZIE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-720-9320
Practice Address - Fax:724-720-9301
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008344101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health