# MR. SAMUEL LEE JOHNSON III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1184095556
- **Gender:** Man
- **Credential:** CAC, CCGC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 1603 | LA | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YP1600X | Pastoral Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | 5006 | LA | — |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 171000000X | Military Health Care Provider | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 175T00000X | Peer Specialist | — | NULL | — |
| 225C00000X | Rehabilitation Counselor | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | 010494439 | LA | — |

## Other

- **Enumeration date:** 10/12/2015
- **Last updated:** 01/12/2021