Individual
MR. RANDY J. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHC
Contact information
Practice address
2235 LEWISVILLE CLEMMONS RD STE A, CLEMMONS, NC 27012-9342
(336) 722-7266
(336) 201-0538
Mailing address
713 S MARSHALL ST, WINSTON SALEM, NC 27101-5808
(336) 722-7266
(336) 201-0538
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
3008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1236V
BCBS OF NC
NC
05
—
6102482
—
NC
05
—
6102747
—
NC
01
—
D0751
MEDCOST
NC
01
—
D9674
MEDCOST
NC
Enumeration date
03/25/2006
Last updated
05/03/2023
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