Provider Demographics
NPI:1588233191
Name:JOHNSON, KATHARINE (MA, LCMHCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KATHARINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LAKE COMPANY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-0135
Mailing Address - Country:US
Mailing Address - Phone:919-815-7301
Mailing Address - Fax:
Practice Address - Street 1:790 CARDINAL RD # 6
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5202
Practice Address - Country:US
Practice Address - Phone:919-404-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health