Provider Demographics
NPI:1871996934
Name:JOHNSON, BETHLYN (MS,LPC, NBCC)
Entity type:Individual
Prefix:
First Name:BETHLYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS,LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1520
Mailing Address - Country:US
Mailing Address - Phone:630-726-4037
Mailing Address - Fax:919-755-0545
Practice Address - Street 1:610 W PEACE ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1520
Practice Address - Country:US
Practice Address - Phone:630-726-4037
Practice Address - Fax:919-755-0545
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health