Basic Information
| Provider Information | |||||||||
| NPI: | 1790092187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHANNES-MONROE | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 W. ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106922444 | ||||||||
| FaxNumber: | 9106923651 | ||||||||
| Practice Location | |||||||||
| Address1: | 195 W ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTHERN PINES | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283875808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106922444 | ||||||||
| FaxNumber: | 9106923651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2010 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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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 | 103T00000X | 4312 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | Q40357A | 01 | NC | MEDICARE | OTHER | 6001374 | 05 | NC | MEDICAID | 17520 | 01 | BCBS | OTHER |