Provider Demographics
NPI:1477184174
Name:JOHNSON, SHARON LEE (PHD, MED, LPC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, MED, LPC
Other - Prefix:
Other - First Name:SHEREE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MED, LPC
Mailing Address - Street 1:100 CABANA CAY CIR # 1-220
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-4662
Mailing Address - Country:US
Mailing Address - Phone:734-255-8488
Mailing Address - Fax:
Practice Address - Street 1:100 CABANA CAY CIR # 1-220
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-4662
Practice Address - Country:US
Practice Address - Phone:734-255-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI6401016054101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty