Provider Demographics
NPI:1083305734
Name:MCCAIN, JOHNETTA
Entity type:Individual
Prefix:MRS
First Name:JOHNETTA
Middle Name:
Last Name:MCCAIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JOHNETTA
Other - Middle Name:
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51310 TIMBER BAY CT
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51310 TIMBER BAY CT
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9812
Practice Address - Country:US
Practice Address - Phone:907-373-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor