Provider Demographics
NPI:1780830596
Name:JOHNSON, ELENA ELOISE (MA, LCMHC, LCAS)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:ELOISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SEQUOYAH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:SC
Mailing Address - Zip Code:29685-2627
Mailing Address - Country:US
Mailing Address - Phone:864-616-3236
Mailing Address - Fax:
Practice Address - Street 1:2113 BALBOA RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2603
Practice Address - Country:US
Practice Address - Phone:864-616-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3470-A101YA0400X
NC3470101YA0400X
NC9417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)