Provider Demographics
NPI:1679379143
Name:JOHNSON, SAVANNAH JO (LPCA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 DARBY CREEK RD # A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1603
Mailing Address - Country:US
Mailing Address - Phone:304-400-2561
Mailing Address - Fax:
Practice Address - Street 1:503 DARBY CREEK RD # A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1603
Practice Address - Country:US
Practice Address - Phone:304-400-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY441542101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor