Provider Demographics
NPI:1851041362
Name:JOHNSON, ROXANNA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROXANNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ROXIANNA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:11210 HUNTINGTON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3564
Mailing Address - Country:US
Mailing Address - Phone:704-779-2030
Mailing Address - Fax:
Practice Address - Street 1:11210 HUNTINGTON MEADOW LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-3564
Practice Address - Country:US
Practice Address - Phone:704-779-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional