Provider Demographics
NPI:1073813408
Name:JOHNSON, OLIVER JAMES (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:JAMES
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0823
Mailing Address - Country:US
Mailing Address - Phone:910-578-5169
Mailing Address - Fax:
Practice Address - Street 1:907 HAY ST STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5352
Practice Address - Country:US
Practice Address - Phone:910-483-5986
Practice Address - Fax:910-483-2876
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-2082101YA0400X
NCC0059341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)