Provider Demographics
NPI:1205444718
Name:JOHNSON, VANESSA LORRAINE ELIZABETH (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:LORRAINE ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 GATES CIR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-4092
Mailing Address - Country:US
Mailing Address - Phone:404-931-0027
Mailing Address - Fax:
Practice Address - Street 1:1388 GATES CIR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4092
Practice Address - Country:US
Practice Address - Phone:404-931-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional