Provider Demographics
NPI:1891216693
Name:JOHNSON, NIKOLE (LCSW)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:
Other - Last Name:SCHIAVONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCISM, LMSW
Mailing Address - Street 1:88 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5566
Mailing Address - Country:US
Mailing Address - Phone:910-634-6664
Mailing Address - Fax:
Practice Address - Street 1:88 SUNNYBROOK LN
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5566
Practice Address - Country:US
Practice Address - Phone:910-634-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0105361041C0700X
NC0136551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical