Basic Information
Provider Information
NPI: 1528106556
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: FRANKLIN
MiddleName: WAYNE
NamePrefix: MR.
NameSuffix:  
Credential: M.A. HSP-PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 207 QUEEN ST
Address2:  
City: MORGANTON
State: NC
PostalCode: 286553341
CountryCode: US
TelephoneNumber: 8284398191
FaxNumber: 8284392622
Practice Location
Address1: 207 QUEEN ST
Address2:  
City: MORGANTON
State: NC
PostalCode: 286553341
CountryCode: US
TelephoneNumber: 8284398191
FaxNumber: 8284392622
Other Information
ProviderEnumerationDate: 02/02/2007
LastUpdateDate: 07/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TH0100X4322NCY Behavioral Health & Social Service ProvidersPsychologistHealth Service

No ID Information.


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