Provider Demographics
NPI:1063762078
Name:JOHNSON, KATHY PAINTER (LCSW-A)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:PAINTER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10241 BLACKWELL RD SE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-8515
Mailing Address - Country:US
Mailing Address - Phone:910-371-5300
Mailing Address - Fax:910-371-5302
Practice Address - Street 1:10241 BLACKWELL RD SE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-8515
Practice Address - Country:US
Practice Address - Phone:910-371-5300
Practice Address - Fax:910-371-5302
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0071411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical