Provider Demographics
NPI:1295107209
Name:JOHNSON, EMILY JUSTINE (MS, LCPC)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:JUSTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5123
Mailing Address - Country:US
Mailing Address - Phone:207-446-5228
Mailing Address - Fax:
Practice Address - Street 1:29 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3531
Practice Address - Country:US
Practice Address - Phone:207-446-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional