Provider Demographics
NPI:1598006827
Name:JOHNSON, CHARLES DUSTIN (MS, EDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DUSTIN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 REDWING RD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2878
Mailing Address - Country:US
Mailing Address - Phone:970-480-0707
Mailing Address - Fax:
Practice Address - Street 1:2625 REDWING RD STE 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2878
Practice Address - Country:US
Practice Address - Phone:970-444-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0011971101Y00000X, 101YP2500X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health