Individual provider Active NPI

Andrieah Johnson, LMHC, CAMS, CCTP

  • Mental Health Counselor
  • Jacksonville, FL
National Provider Identifier
1760809115
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH14518 Issued in FL
Practice address
1222 Clock St
Jacksonville, FL 32211-8853
Phone
(904) 577-0087
Fax
(844) 846-2463
NPI assigned
Mar 24, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 14518 FL
Mental Health Counselor 101YM0800X IMH11851 FL
Mental Health Counselor 101YM0800X MH14518 FL Primary

Addresses

Primary practice location

1222 Clock St
Jacksonville, FL 32211-8853

Mailing address

7643 Gate Pkwy Ste 104-1139
Jacksonville, FL 32256-3092
Phone (904) 577-0087

Other practice location 1

4595 Lexington Ave
Jacksonville, FL 32210-2058
Phone (904) 448-4700 ext. 507

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
14518FLMDMental Health Counselor
IMH11851FLMDMental Health Counselor
MH14518FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Connected Conversations Counseling, L.L.C. Mental Health CurrentSince Oct 23, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1760809115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7643 GATE PKWY STE 104-1139",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322563092",
            "telephone_number": "904-577-0087",
            "fax_number": "844-846-2463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 CLOCK ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322118853",
            "telephone_number": "904-577-0087",
            "fax_number": "844-846-2463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4595 Lexington Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322102058",
            "country_code": "US",
            "telephone_number": "904-448-4700 x507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANDRIEAH",
        "credential": "LMHC, CAMS, CCTP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-24",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "14518",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH11851",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH14518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.