Provider Demographics
NPI:1194838664
Name:JOHNSON, DEA MARIE (LCSW, CADC, SAP)
Entity Type:Individual
Prefix:MS
First Name:DEA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, CADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MID AMERICA PLZ
Mailing Address - Street 2:SUITE 800
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4451
Mailing Address - Country:US
Mailing Address - Phone:630-675-7686
Mailing Address - Fax:630-691-0901
Practice Address - Street 1:2 MID AMERICA PLZ
Practice Address - Street 2:SUITE 800
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4451
Practice Address - Country:US
Practice Address - Phone:630-675-7686
Practice Address - Fax:630-691-0901
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18153101YA0400X
IL149-0100641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL237950OtherCOMPSYCH
IL508694OtherVALUE OPTIONS
IL33-1073431OtherCORP HEALTH/HUMANA
IL720545000OtherMAGELLAN
IL784852OtherAETNA/MANAGED CHOICE
IL2207910OtherCIGNA BEHAVIORAL HEALTH
IL02232414OtherBCBS
IL025050OtherVMC BEHAVIORAL HEALTHCARE
ILMULTIPLANOtherMULTIPLAN