Provider Demographics
NPI:1962139048
Name:JOHNSON, JAMES GILMER (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GILMER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:440 OLD US 19 E
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-6106
Mailing Address - Country:US
Mailing Address - Phone:828-766-9966
Mailing Address - Fax:
Practice Address - Street 1:JAMES H QUILLEN VETERANS AFFAIRS MEDICAL CENTER
Practice Address - Street 2:SYDNEY AND LAMONT STREET MOUNTAIN HOME, TN 37684
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-2812
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0071711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC007171OtherCLINICAL SOCIAL WORKER