Provider Demographics
NPI:1770658247
Name:JOHNSON, NANCY A (LPCC LADAC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 OSUNA RD NE STE A2
Mailing Address - Street 2:BLDG. A-2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5953
Mailing Address - Country:US
Mailing Address - Phone:505-346-0824
Mailing Address - Fax:505-341-2287
Practice Address - Street 1:320 OSUNA RD NE STE A2
Practice Address - Street 2:BLDG. A-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5953
Practice Address - Country:US
Practice Address - Phone:505-346-0824
Practice Address - Fax:505-341-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02-103316-00-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health