Basic Information
| Provider Information | |||||||||
| NPI: | 1396031787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | GERI | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.DIV., NCAC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287863250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284568604 | ||||||||
| FaxNumber: | 8284569018 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | WAYNESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287863250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284568604 | ||||||||
| FaxNumber: | 8284569018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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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 | 101YP1600X | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YP2500X | 9518 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 1851 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.