Provider Demographics
NPI:1336364561
Name:JOHNSON, LINDA JOYCE (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:GROVES
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:519 N CEDAR RIDGE DR
Mailing Address - Street 2:STE. 3
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3183
Mailing Address - Country:US
Mailing Address - Phone:972-298-3614
Mailing Address - Fax:972-709-8145
Practice Address - Street 1:519 N CEDAR RIDGE DR
Practice Address - Street 2:STE. 3
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3183
Practice Address - Country:US
Practice Address - Phone:972-298-3614
Practice Address - Fax:972-709-8145
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional