Individual
MR. KYLE H JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
805 LANIER AVE E, FAYETTEVILLE, GA 30214-2204
(770) 694-6349
Mailing address
14 PINE GROVE CT, LAGRANGE, GA 30241-8052
(706) 402-7771
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC010040
GA
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
04/29/2019
Last updated
01/22/2024
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