1528589330 NPI number — MRS. CANDACE NICHOLE JOHNSON MS,NCC,LPC

Table of content: MRS. CANDACE NICHOLE JOHNSON MS,NCC,LPC (NPI 1528589330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528589330 NPI number — MRS. CANDACE NICHOLE JOHNSON MS,NCC,LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CANDACE
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS,NCC,LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
CANDACE
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528589330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4512 BOLTON NOTCH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17110-3414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-708-7482
Provider Business Mailing Address Fax Number:
717-796-5246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17101-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-238-8118
Provider Business Practice Location Address Fax Number:
717-238-8140
Provider Enumeration Date:
06/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC009717 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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