Provider Demographics
NPI:1932541901
Name:JOHNSON, CARRIE LYNN (MS, NCC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BUSINESS WAY, #52
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-9998
Mailing Address - Country:US
Mailing Address - Phone:239-312-5352
Mailing Address - Fax:239-230-3029
Practice Address - Street 1:6315 PRESIDENTIAL CT STE 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3568
Practice Address - Country:US
Practice Address - Phone:239-312-5352
Practice Address - Fax:239-230-3029
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLLMHC17003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL591287693Medicaid