Provider Demographics
NPI:1114406436
Name:JOHNSON, NAOMI (LCAS-A)
Entity type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 PINE KNOLL TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3177
Mailing Address - Country:US
Mailing Address - Phone:336-675-2806
Mailing Address - Fax:
Practice Address - Street 1:2250 PINE KNOLL TER
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217
Practice Address - Country:US
Practice Address - Phone:336-675-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22128101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)