Provider Demographics
NPI:1730648874
Name:JOHNSON, ROSHELLE ANNETTE (LPC)
Entity Type:Individual
Prefix:PROF
First Name:ROSHELLE
Middle Name:ANNETTE
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 1:1825 E NORTHERN AVE STE 135E
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3979
Mailing Address - Country:US
Mailing Address - Phone:602-377-7304
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE STE 135E
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3979
Practice Address - Country:US
Practice Address - Phone:602-377-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health