Provider Demographics
NPI:1750631057
Name:JOHNSON, TERESA L (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-1247
Mailing Address - Country:US
Mailing Address - Phone:603-865-1934
Mailing Address - Fax:855-899-6197
Practice Address - Street 1:513 SILVERS WELCH RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-8752
Practice Address - Country:US
Practice Address - Phone:603-865-1934
Practice Address - Fax:855-899-6197
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4778103TC1900X
ID203304103TC1900X
NH1265103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling