Provider Demographics
NPI:1023657145
Name:JOHNSON, CONSTANCE TONYA (LPC)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:TONYA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-2388
Mailing Address - Country:US
Mailing Address - Phone:478-290-3833
Mailing Address - Fax:
Practice Address - Street 1:724 MILLER LN
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-2388
Practice Address - Country:US
Practice Address - Phone:478-290-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional