Provider Demographics
NPI:1467235143
Name:TL JOHNSON COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TL JOHNSON COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-334-4056
Mailing Address - Street 1:PO BOX 36144
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0502
Mailing Address - Country:US
Mailing Address - Phone:803-334-4056
Mailing Address - Fax:
Practice Address - Street 1:TRACEY JOHNSON
Practice Address - Street 2:150 OAKLAND AVE. SUITE 200
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4068
Practice Address - Country:US
Practice Address - Phone:803-334-4056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center