Provider Demographics
NPI:1649900069
Name:JOHNSON, JOSHUA TERRILL (MED, LPC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TERRILL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:TERRILL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, NCC ,LPC
Mailing Address - Street 1:PO BOX 24449
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-0589
Mailing Address - Country:US
Mailing Address - Phone:833-351-8255
Mailing Address - Fax:
Practice Address - Street 1:10 GLENLAKE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3495
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC200001630101YP2500X
TX94048101YP2500X
GALPC013047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional