Provider Demographics
NPI:1093029803
Name:JOHANSSON, ADELE E, (LPC, CACD)
Entity type:Individual
Prefix:MS
First Name:ADELE
Middle Name:E,
Last Name:JOHANSSON
Suffix:
Gender:F
Credentials:LPC, CACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CUMBERLAND PARKWAY
Mailing Address - Street 2:SUITE NUMBER 5
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5663
Mailing Address - Country:US
Mailing Address - Phone:717-364-8765
Mailing Address - Fax:
Practice Address - Street 1:220 CUMBERLAND PKWY
Practice Address - Street 2:SUITE #5
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5683
Practice Address - Country:US
Practice Address - Phone:717-364-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2627101YA0400X
PAPC003003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)