Provider Demographics
NPI:1063451169
Name:JOHNSON, GLORIA FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:FAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1314
Mailing Address - Country:US
Mailing Address - Phone:214-376-8428
Mailing Address - Fax:214-376-0756
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:(116A)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0839
Practice Address - Fax:214-857-0917
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX049641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical