Provider Demographics
NPI:1962156299
Name:JOHNSON, CAROLINE (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:NEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12731 LONGVIEW PARK LN
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6999
Mailing Address - Country:US
Mailing Address - Phone:208-608-4416
Mailing Address - Fax:
Practice Address - Street 1:12731 LONGVIEW PARK LN
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6999
Practice Address - Country:US
Practice Address - Phone:208-608-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099259441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical