Provider Demographics
NPI:1124295191
Name:JOHNSON, GREGORY TERENCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:TERENCE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-751-8000
Mailing Address - Fax:336-751-8010
Practice Address - Street 1:485 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2074
Practice Address - Country:US
Practice Address - Phone:336-751-8000
Practice Address - Fax:336-751-8010
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical