Individual
MR. TIMOTHY JOHNSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BACHELOR OF PSYCHOLO
Contact information
Practice address
207 PERRY WILEY WAY, CHESTERFIELD, SC 29709
(843) 423-8292
(843) 423-8294
Mailing address
PO BOX 918, BENNETTSVILLE, SC 29512
(843) 544-4060
(843) 454-0635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251S00000X
—
SC
05
—
405127
—
SC
Enumeration date
10/13/2020
Last updated
10/26/2022
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