Provider Demographics
NPI:1740658376
Name:JOHNSON, CHARRYSE (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:CHARRYSE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 FAIRVIEW RD STE 420
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3167
Mailing Address - Country:US
Mailing Address - Phone:980-701-4192
Mailing Address - Fax:980-701-4194
Practice Address - Street 1:5970 FAIRVIEW RD STE 420
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3167
Practice Address - Country:US
Practice Address - Phone:980-236-1511
Practice Address - Fax:704-919-5460
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11709101Y00000X, 101YM0800X, 101YP2500X
NCA11709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11709OtherLICENSE NUMBER