Provider Demographics
NPI:1568493336
Name:JOHNSON, ANDREA N (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:NELCH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3270 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-2515
Mailing Address - Country:US
Mailing Address - Phone:217-793-0509
Mailing Address - Fax:217-793-0509
Practice Address - Street 1:3270 MOORE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-2515
Practice Address - Country:US
Practice Address - Phone:217-899-3217
Practice Address - Fax:217-793-0509
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist