Provider Demographics
NPI:1558786483
Name:JOHNSON, HARVIE VANCE
Entity type:Individual
Prefix:MR
First Name:HARVIE
Middle Name:VANCE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BROOK VALLEY RUN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-6345
Mailing Address - Country:US
Mailing Address - Phone:704-292-0339
Mailing Address - Fax:
Practice Address - Street 1:1018 BROOK VALLEY RUN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-6345
Practice Address - Country:US
Practice Address - Phone:704-292-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9643101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional