Provider Demographics
NPI:1235312059
Name:JOHNSON, LEON (LCMHC-S)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LCMHC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CANTATA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5465
Mailing Address - Country:US
Mailing Address - Phone:252-814-6596
Mailing Address - Fax:252-752-6464
Practice Address - Street 1:125-A OAKMONT DR
Practice Address - Street 2:SUITE #3
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-814-6596
Practice Address - Fax:252-752-6464
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS6815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health