| Doctor Name: | MRS. SHELLY NICOLE JOHNSON |
| NPI Number: | 1386702736 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA CAS LPC NCC |
| License Number: | 1739 |
| Business Practice Address: | 70 Maranatha Drive Fairmont, WV - 26554 |
| Business Phone Number: | 3046129499 |
| Business Fax Number: | 3042787250 |
| Mailing Address: | 72 Chestnut Street, RIVESVILLE |
| State: | WV |
| Postal Code: | 26588 |
| Phone Number: | 3042787250 |
| Fax Number: | 3042787250 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 1739 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |