Provider Demographics
NPI:1316048812
Name:JOHNSON, CATHRYN B (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHRYN
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CATHRYN
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 CLEVELAND AVE
Mailing Address - Street 2:614
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315
Mailing Address - Country:US
Mailing Address - Phone:404-767-3303
Mailing Address - Fax:404-767-3304
Practice Address - Street 1:777 CLEVELAND AVE
Practice Address - Street 2:614
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315
Practice Address - Country:US
Practice Address - Phone:404-767-3303
Practice Address - Fax:404-767-3304
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW1587101YA0400X
GACSW001587101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000649305CMedicaid
GA000649305CMedicaid
GAR8091Medicare UPIN