Basic Information
| Provider Information | |||||||||
| NPI: | 1013073329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 BURLEYSON DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | DALTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307202522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062705002 | ||||||||
| FaxNumber: | 7062405111 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 ENTERPRISE PATH STE 206 | ||||||||
| Address2: | |||||||||
| City: | HIRAM | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301412654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785670920 | ||||||||
| FaxNumber: | 6785670950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC004612 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.