Provider Demographics
NPI:1326314667
Name:JOHNSON, PAMELA DESHAWN (LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DESHAWN
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 1:4751 BEST RD STE 400G
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-5609
Mailing Address - Country:US
Mailing Address - Phone:470-645-2756
Mailing Address - Fax:404-953-6046
Practice Address - Street 1:4751 BEST RD STE 400G
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-5609
Practice Address - Country:US
Practice Address - Phone:470-645-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007455101YP2500X
GANCC 259849101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health