Provider Demographics
NPI:1528097334
Name:JOHNSON-GILBERT, YVONNE (LCSW,DCSW,ATODS,CCJS)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:
Last Name:JOHNSON-GILBERT
Suffix:
Gender:F
Credentials:LCSW,DCSW,ATODS,CCJS
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 30
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-0030
Mailing Address - Country:US
Mailing Address - Phone:828-648-8052
Mailing Address - Fax:828-648-8052
Practice Address - Street 1:20 COWBOY WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-9411
Practice Address - Country:US
Practice Address - Phone:282-648-8052
Practice Address - Fax:828-648-8052
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88187467OtherLCSW,DCSW, ATODS,CCJS.
NC6002305Medicaid
NC6002305Medicaid