Provider Demographics
NPI:1417350737
Name:JOHNSON, MOLLY (MS/EDS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS/EDS, 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 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:30 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-394-1574
Practice Address - Fax:828-252-0969
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC 320116101YP2500X
NCA10497101YP2500X
NC10497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional