Individual
MR. KENNETH W. JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.S., LPC
Contact information
Practice address
115 NORTHSIDE DR W, SUITE 115, STATESBORO, GA 30458-5399
(912) 489-5480
(912) 489-0886
Mailing address
PO BOX 1532, (315 MEADOWLARK CIRCLE, MERRYWOOD SUBDIVISION), STATESBORO, GA 30459-1532
(912) 489-5480
(912) 764-4113
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
047974
GA
Other
Enumeration date
05/12/2006
Last updated
07/08/2007
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