Provider Demographics
NPI:1104067065
Name:JOHNSON, FLYNN ANDREW (LCMHC)
Entity type:Individual
Prefix:MR
First Name:FLYNN
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WARDSBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05355-9700
Mailing Address - Country:US
Mailing Address - Phone:802-896-6271
Mailing Address - Fax:
Practice Address - Street 1:35 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:WARDSBORO
Practice Address - State:VT
Practice Address - Zip Code:05355-9700
Practice Address - Country:US
Practice Address - Phone:802-896-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health