Provider Demographics
NPI:1508263393
Name:JOHNSON, ANGELA JEAN (LPC, LCAS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:CHAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 MORNINGSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-3229
Mailing Address - Country:US
Mailing Address - Phone:651-323-0029
Mailing Address - Fax:
Practice Address - Street 1:141 MORNINGSIDE LN
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-3229
Practice Address - Country:US
Practice Address - Phone:651-323-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24547101YA0400X
NC14782101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health