Provider Demographics
NPI:1639822315
Name:JOHNSON, ANGEL SHANIECE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:SHANIECE
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 1:107 FENTON CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-3581
Mailing Address - Country:US
Mailing Address - Phone:205-356-6488
Mailing Address - Fax:
Practice Address - Street 1:190 LIME QUARRY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8962
Practice Address - Country:US
Practice Address - Phone:256-270-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional