Provider Demographics
NPI:1679824569
Name:JOHNSON, AVIS C (LCMHC)
Entity type:Individual
Prefix:
First Name:AVIS
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MINTURN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-2137
Mailing Address - Country:US
Mailing Address - Phone:910-461-9097
Mailing Address - Fax:
Practice Address - Street 1:603 MINTURN AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-2137
Practice Address - Country:US
Practice Address - Phone:910-461-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC9416101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health