Provider Demographics
NPI:1396256079
Name:JOHNSON, ASHLEY OSBORNE (LCAS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:OSBORNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1845
Mailing Address - Country:US
Mailing Address - Phone:919-960-3775
Mailing Address - Fax:
Practice Address - Street 1:410 N GREENSBORO ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1845
Practice Address - Country:US
Practice Address - Phone:919-960-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23803101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)