Provider Demographics
NPI:1306150099
Name:JOHNSON, AMY L (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S. GROVE ST.
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4007
Mailing Address - Country:US
Mailing Address - Phone:828-697-2660
Mailing Address - Fax:828-697-2986
Practice Address - Street 1:120 S. GROVE ST.
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-4007
Practice Address - Country:US
Practice Address - Phone:828-697-2660
Practice Address - Fax:828-697-2986
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3067101YA0400X
NCC0066101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)