Provider Demographics
NPI:1992320980
Name:ERIC JOHNSON LLC
Entity type:Organization
Organization Name:ERIC JOHNSON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DRUG & ALCOHOL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLADC
Authorized Official - Phone:402-309-6981
Mailing Address - Street 1:2801 KIPLING CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2752
Mailing Address - Country:US
Mailing Address - Phone:402-309-6981
Mailing Address - Fax:
Practice Address - Street 1:301 S 70TH ST STE 313
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2469
Practice Address - Country:US
Practice Address - Phone:402-309-6981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP-1733OtherSTATE PROFESSIONAL LICENSE-PLADC