Provider Demographics
NPI:1053647891
Name:JOHNSON, CORTRINA LYNN (MSW/LCASA)
Entity Type:Individual
Prefix:MS
First Name:CORTRINA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW/LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HALLOW OAK ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9811
Mailing Address - Country:US
Mailing Address - Phone:910-670-7119
Mailing Address - Fax:
Practice Address - Street 1:1001 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7251
Practice Address - Country:US
Practice Address - Phone:910-670-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0053761041C0700X
NC2792A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP005376OtherPROVISIONAL LICENSED CLINICAL SOCIAL WORKER NUMBER