Provider Demographics
NPI:1285372276
Name:JOHNSON, SANDY S (LPC-S)
Entity type:Individual
Prefix:MS
First Name:SANDY
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 HACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-3021
Mailing Address - Country:US
Mailing Address - Phone:334-220-4634
Mailing Address - Fax:
Practice Address - Street 1:3239 HACKBERRY LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3021
Practice Address - Country:US
Practice Address - Phone:334-220-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional