Provider Demographics
NPI:1013651439
Name:JOHNSON-ANDERSON, CYNTHIA GAIL (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:GAIL
Last Name:JOHNSON-ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 EDGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-4007
Mailing Address - Country:US
Mailing Address - Phone:334-590-7877
Mailing Address - Fax:
Practice Address - Street 1:4017 EDGE HILL LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-4007
Practice Address - Country:US
Practice Address - Phone:334-590-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2415101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL27-4300809Medicaid