Provider Demographics
NPI:1538648860
Name:JOHNSON, MICHAEL DARNEL SR (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DARNEL
Last Name:JOHNSON
Suffix:SR
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 1:1705 KINSER CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-1670
Mailing Address - Country:US
Mailing Address - Phone:757-506-8665
Mailing Address - Fax:
Practice Address - Street 1:1705 KINSER CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2332
Practice Address - Country:US
Practice Address - Phone:757-506-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional