Provider Demographics
NPI:1255714796
Name:JOHNSON, ANGELA EVANN (LPC-MHSP, NCC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:EVANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 128
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065
Mailing Address - Country:US
Mailing Address - Phone:615-814-2951
Mailing Address - Fax:615-567-7322
Practice Address - Street 1:3326 ASPEN GROVE DRIVE
Practice Address - Street 2:SUITE 603
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-814-2951
Practice Address - Fax:615-567-7322
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor