Provider Demographics
NPI:1568865673
Name:JOHNSON, BETHANY (LCPC, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 NORTH ST APT 606
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1857
Mailing Address - Country:US
Mailing Address - Phone:207-281-2460
Mailing Address - Fax:
Practice Address - Street 1:342 NORTH ST APT 606
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1857
Practice Address - Country:US
Practice Address - Phone:072-812-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5947101YA0400X
MECC5612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)