Provider Demographics
NPI:1861884363
Name:JOHNSON, QUINCY (LPC)
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7909 SUMTER PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0667
Mailing Address - Country:US
Mailing Address - Phone:803-467-0414
Mailing Address - Fax:
Practice Address - Street 1:2003 E NC HIGHWAY 54 STE C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2483
Practice Address - Country:US
Practice Address - Phone:919-682-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10853101YM0800X
NC10853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health