Provider Demographics
NPI:1962525832
Name:JOHNSON, STEVE C (LMSW, LPCC)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMSW, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 AMIGO WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1546
Mailing Address - Country:US
Mailing Address - Phone:505-275-4740
Mailing Address - Fax:
Practice Address - Street 1:5608 AMIGO WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1546
Practice Address - Country:US
Practice Address - Phone:505-275-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0295101YP2500X
NMM1634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker