Provider Demographics
NPI:1649406604
Name:JOHNSON, MICHELE ELIZABETH (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 FIRST COAST HWY
Mailing Address - Street 2:STE 119
Mailing Address - City:AMELIA ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5423
Mailing Address - Country:US
Mailing Address - Phone:904-432-7617
Mailing Address - Fax:904-432-7088
Practice Address - Street 1:5422 FIRST COAST HWY
Practice Address - Street 2:STE 119
Practice Address - City:AMELIA ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32034-5423
Practice Address - Country:US
Practice Address - Phone:904-432-7617
Practice Address - Fax:904-432-7088
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health