Provider Demographics
NPI:1801090980
Name:JOHNSON, KIMBERLY ANNE (LPC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:ANNE
Other - Last Name:RAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 W BLUEMONT ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1242
Mailing Address - Country:US
Mailing Address - Phone:043-265-0312
Mailing Address - Fax:304-265-0314
Practice Address - Street 1:14311 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MOUNT STORM
Practice Address - State:WV
Practice Address - Zip Code:26739-8757
Practice Address - Country:US
Practice Address - Phone:304-693-7616
Practice Address - Fax:304-693-7776
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023397001Medicaid