Provider Demographics
NPI:1760809115
Name:JOHNSON, ANDRIEAH (LMHC, CAMS, CCTP)
Entity Type:Individual
Prefix:
First Name:ANDRIEAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC, CAMS, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 GATE PKWY STE 104-1139
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3092
Mailing Address - Country:US
Mailing Address - Phone:904-577-0087
Mailing Address - Fax:844-846-2463
Practice Address - Street 1:1222 CLOCK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8853
Practice Address - Country:US
Practice Address - Phone:904-577-0087
Practice Address - Fax:844-846-2463
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14518101YM0800X
FLIMH11851101YM0800X
FLMH14518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health