Individual
STACEY L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
12160 SUMMERWOOD DR, CONCORD TWP, OH 44077-8525
(216) 598-5202
Mailing address
12160 SUMMERWOOD DR, CONCORD TWP, OH 44077-8525
(216) 598-5202
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
E.0003690
OH
101YP2500X
Professional Counselor
E0003690
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0187344
—
OH
Enumeration date
09/17/2016
Last updated
10/18/2022
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