Provider Demographics
NPI:1578931333
Name:JOHNSON, RENEE SHULL (MA, NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:SHULL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20816 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8468
Mailing Address - Country:US
Mailing Address - Phone:704-761-8225
Mailing Address - Fax:
Practice Address - Street 1:709 NORTHEAST DR STE 22
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:336-209-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health