Provider Demographics
NPI:1447288220
Name:JOHNSON, KIM ANNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N FRONT ST STE 215
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5095
Mailing Address - Country:US
Mailing Address - Phone:910-981-2144
Mailing Address - Fax:910-792-9883
Practice Address - Street 1:201 N FRONT ST STE 215
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5095
Practice Address - Country:US
Practice Address - Phone:910-981-2144
Practice Address - Fax:910-240-9814
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 106H00000X
NC1311106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105266Medicaid