Provider Demographics
NPI:1104314459
Name:JOHNSON, ALLANA DIANNE (LPC)
Entity type:Individual
Prefix:
First Name:ALLANA
Middle Name:DIANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 WILLOW LK
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8031
Mailing Address - Country:US
Mailing Address - Phone:706-414-5051
Mailing Address - Fax:
Practice Address - Street 1:6130 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3820
Practice Address - Country:US
Practice Address - Phone:803-226-0190
Practice Address - Fax:803-226-0258
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health