Provider Demographics
NPI:1770997710
Name:JOHNSON, PATRINA MOSS (LAPC; NCC)
Entity type:Individual
Prefix:
First Name:PATRINA
Middle Name:MOSS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAPC; NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:612 EAST BROAD STREET
Mailing Address - Street 2:SEAPORT CHRISTIAN COIUNSELING
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401
Mailing Address - Country:US
Mailing Address - Phone:912-239-5711
Mailing Address - Fax:912-233-0901
Practice Address - Street 1:612 E BROAD ST
Practice Address - Street 2:SEAPORT CHRISTIAN COIUNSELING
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5110
Practice Address - Country:US
Practice Address - Phone:912-239-5711
Practice Address - Fax:912-233-0901
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health