Provider Demographics
NPI:1134955875
Name:JOHNSON, ELISHA (LPCC)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LEESTOWN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-2045
Mailing Address - Country:US
Mailing Address - Phone:859-813-0323
Mailing Address - Fax:
Practice Address - Street 1:1500 LEESTOWN RD STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2045
Practice Address - Country:US
Practice Address - Phone:859-813-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health