Provider Demographics
NPI:1356910665
Name:JOHNSON, LOREN (MA, LPC, LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LPC, LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5622 CAPITO ST
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4804
Mailing Address - Country:US
Mailing Address - Phone:540-915-3966
Mailing Address - Fax:
Practice Address - Street 1:5622 CAPITO ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4804
Practice Address - Country:US
Practice Address - Phone:540-915-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor