Provider Demographics
NPI:1841544947
Name:JOHNSON, ANNEKE (MA, LPC, LMHC,LCHMCS)
Entity type:Individual
Prefix:MS
First Name:ANNEKE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC, LMHC,LCHMCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 WESTERN BLVD # 1008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6651
Mailing Address - Country:US
Mailing Address - Phone:571-206-1121
Mailing Address - Fax:910-541-9488
Practice Address - Street 1:2845 BEATTIES FORD RD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216
Practice Address - Country:US
Practice Address - Phone:571-206-1121
Practice Address - Fax:910-541-9488
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional