Provider Demographics
NPI:1881278448
Name:JOHNSON, TERRA (LMHC)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 PANOLA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3851
Mailing Address - Country:US
Mailing Address - Phone:678-964-1868
Mailing Address - Fax:949-561-4954
Practice Address - Street 1:2600 BENTLEY RD SE APT 313
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-3200
Practice Address - Country:US
Practice Address - Phone:678-964-1868
Practice Address - Fax:949-561-4954
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional