Provider Demographics
NPI:1033490115
Name:JOHNSON, CORRELIA D (LCSW, LCAS, LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:CORRELIA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LCAS, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 PERIMETER PARKWAY SUITE 200 - #0425
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216
Mailing Address - Country:US
Mailing Address - Phone:980-230-8880
Mailing Address - Fax:844-841-1302
Practice Address - Street 1:INNER TRANSFORMATION THERAPEUTIC SERVICES, PLLC
Practice Address - Street 2:10130 PERIMETER PARKWAY SUITE 200 - #0425
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216
Practice Address - Country:US
Practice Address - Phone:980-230-8880
Practice Address - Fax:844-841-1302
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20894101YA0400X
SC111781041C0700X
NCC0085211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)