Provider Demographics
NPI:1831832955
Name:JOHNSON, CLIFFORD L (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1912
Mailing Address - Country:US
Mailing Address - Phone:404-310-6916
Mailing Address - Fax:404-420-2220
Practice Address - Street 1:1805 E GATE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1912
Practice Address - Country:US
Practice Address - Phone:404-310-6916
Practice Address - Fax:404-420-2220
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC12662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty