Provider Demographics
NPI:1992978167
Name:JOHNSON, ANGELA DIANE (MSSW,CSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW,CSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DIANE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-272-5448
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:411 E CHESTNUT ST # STREET1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-3440
Practice Address - Fax:502-588-3441
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical