Provider Demographics
NPI:1750631057
Name:JOHNSON, TERESA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 MARKET ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3752
Mailing Address - Country:US
Mailing Address - Phone:603-865-1934
Mailing Address - Fax:603-290-5640
Practice Address - Street 1:5 MARKET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3752
Practice Address - Country:US
Practice Address - Phone:603-865-1934
Practice Address - Fax:603-290-5640
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4778103TC1900X
ID203304103TC1900X
NH1265103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling