Provider Demographics
NPI:1679381834
Name:JOHNSON, STEPHANIE DAWN (LPC)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-0800
Mailing Address - Country:US
Mailing Address - Phone:478-633-5500
Mailing Address - Fax:478-784-5496
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-633-5500
Practice Address - Fax:478-784-5496
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty