Provider Demographics
NPI:1003545609
Name:JOHNSON, VICTORIA N (CD(DONA))
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 NEW BERN AVENUE
Mailing Address - Street 2:SUITE 130- BOX 261
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:252-955-4293
Mailing Address - Fax:
Practice Address - Street 1:6118 SAINT GILES ST STE 120
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7045
Practice Address - Country:US
Practice Address - Phone:252-955-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14774374J00000X
NCP0164981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula