Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | LPC010805 | GA |
NPI | 1083234678 |
---|---|
Provider Name | Faith Johnson |
First Address | Carrollton, GA 30117-8787 |
Second Address | Carrollton, GA 30117-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2020 |
Last Update Date | 23/04/2020 |