Provider Demographics
NPI:1649596263
Name:JOHNSON, CHRISTINE (LP:C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LP:C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 EDMUND HWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9581
Mailing Address - Country:US
Mailing Address - Phone:803-755-0681
Mailing Address - Fax:
Practice Address - Street 1:5755 EDMUND HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-9581
Practice Address - Country:US
Practice Address - Phone:803-755-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5155101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional