Individual provider Active NPI

Elena Eloise Johnson, MA, LCMHC, LCAS

  • Professional Counselor
  • Raleigh, NC
National Provider Identifier
1780830596
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
9417 Issued in NC
Practice address
2113 Balboa Rd Ste 300
Raleigh, NC 27603-2603
Phone
(864) 616-3236
NPI assigned
Aug 12, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 3470-A NC
Addiction (Substance Use Disorder) Counselor 101YA0400X 3470 NC
Professional Counselor 101YP2500X 9417 NC Primary

Addresses

Primary practice location

2113 Balboa Rd Ste 300
Raleigh, NC 27603-2603

Mailing address

242 Sequoyah Way
Sunset, SC 29685-2627
Phone (864) 616-3236

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
3470-ANCMDAddiction (Substance Use Disorder) Counselor
9417NCMDDentist
3470NCMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1780830596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 SEQUOYAH WAY",
            "city": "SUNSET",
            "state": "SC",
            "postal_code": "296852627",
            "telephone_number": "864-616-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2113 BALBOA RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276032603",
            "telephone_number": "864-616-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ELENA",
        "middle_name": "ELOISE",
        "credential": "MA, LCMHC, LCAS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3470-A",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "3470",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "9417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; 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.