Provider Demographics
NPI:1467996942
Name:JOHNSON, ORVILLE W JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:ORVILLE
Middle Name:W
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N ALSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3510
Mailing Address - Country:US
Mailing Address - Phone:251-269-1819
Mailing Address - Fax:
Practice Address - Street 1:820 N ALSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3510
Practice Address - Country:US
Practice Address - Phone:251-269-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3622101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor