Provider Demographics
NPI:1457580615
Name:JOHNSON, ANGEL G (MA, LPC, LPCS, LCMHC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, LPCS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1276
Mailing Address - Country:US
Mailing Address - Phone:803-708-7990
Mailing Address - Fax:803-636-2637
Practice Address - Street 1:6156 SAINT ANDREWS RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3147
Practice Address - Country:US
Practice Address - Phone:803-708-7990
Practice Address - Fax:803-636-2637
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20014101YM0800X
FLTPMC4870101YM0800X
SC4956101YM0800X
SC5215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1142Medicaid
SC322842Medicaid