Provider Demographics
NPI:1558549840
Name:JOHNSON, NANCY A (EDD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7455
Practice Address - Fax:407-650-7416
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health