Kimberly Anne Johnson, LPC
Individual provider Active NPI Counselor · Mount Storm, WV
NPI 1801090980 · NPPES record last updated Dec 14, 2022
Key facts
- NPI
- 1801090980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 14311 George Washington Hwy
Mount Storm, WV 26739-8757 - Phone
- (304) 693-7616
- Fax
- (304) 693-7776
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240619000866 | WV | Practitioner - Mental Health Counselor | 9931560448 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
14311 George Washington Hwy
Mount Storm, WV 26739-8757
Mailing address
25 W Bluemont St
Grafton, WV 26354-1242
Phone (043) 265-0312
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0023397001 | Medicaid | WV |
Other names
- Mrs. Kim Anne Rause
Other providers in Mount Storm, WV
- Shanna Nicole Bonner
- Kimberley Costello
- Grant Memorial Hospital
- Sarah Beth Hunt
- Zachary Idleman
- Abbi Nichole Kifer
- Allan B Kunkel
- Carolyn Lower
- Preston Taylor Community Health Centers Incorporated
- Preston Taylor Community Health Centers, Incorporated
All providers in Mount Storm, WV · Counselor in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.