Provider Demographics
NPI:1457403792
Name:JOHNSON JONES, JOHNNIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOHNNIE
Middle Name:
Last Name:JOHNSON JONES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9087
Mailing Address - Country:US
Mailing Address - Phone:910-485-4989
Mailing Address - Fax:910-485-4281
Practice Address - Street 1:108 HAY ST SUITE 226A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5650
Practice Address - Country:US
Practice Address - Phone:910-485-4989
Practice Address - Fax:910-485-4281
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139M3OtherBCBS
NC6102429Medicaid