Provider Demographics
NPI:1093283186
Name:JOHNSON, DANARA (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:DANARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25619 PLEASANT PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-7610
Mailing Address - Country:US
Mailing Address - Phone:720-878-2955
Mailing Address - Fax:
Practice Address - Street 1:190 E 9TH AVE STE 290
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2744
Practice Address - Country:US
Practice Address - Phone:720-878-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000918101YA0400X
COCSW.099248271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)