Provider Demographics
NPI:1770292302
Name:JOHNSON, KAMIA ALEXIS (LCMHCA)
Entity type:Individual
Prefix:MS
First Name:KAMIA
Middle Name:ALEXIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 POUNDS AVE SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4789
Mailing Address - Country:US
Mailing Address - Phone:704-577-5356
Mailing Address - Fax:
Practice Address - Street 1:9541 JULIAN CLARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3485
Practice Address - Country:US
Practice Address - Phone:980-358-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health