Provider Demographics
NPI:1538704291
Name:JOHNSON, IAN CHRISTOPHER (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:CHRISTOPHER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WINDING HILL DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5670
Mailing Address - Country:US
Mailing Address - Phone:973-454-8423
Mailing Address - Fax:
Practice Address - Street 1:100-140 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-4624
Practice Address - Country:US
Practice Address - Phone:973-589-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00654200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional