Provider Demographics
NPI:1609521053
Name:JOHNSON, SHONDA (LPC)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 DATA DR STE 155
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1237
Mailing Address - Country:US
Mailing Address - Phone:205-982-3586
Mailing Address - Fax:205-982-5976
Practice Address - Street 1:1855 DATA DR STE 155
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1237
Practice Address - Country:US
Practice Address - Phone:205-982-3586
Practice Address - Fax:205-982-5976
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2193101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional