Provider Demographics
NPI:1225416399
Name:JOHNSON, VALERIE (BGS, LCDC, ADC III,)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BGS, LCDC, ADC III,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-1632
Mailing Address - Country:US
Mailing Address - Phone:817-921-2272
Mailing Address - Fax:817-921-2272
Practice Address - Street 1:1313 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-1632
Practice Address - Country:US
Practice Address - Phone:817-921-2272
Practice Address - Fax:817-921-2272
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10074101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)