Provider Demographics
NPI:1306002456
Name:JOHNSON, RONNIE B (BA)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9330 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2858
Mailing Address - Country:US
Mailing Address - Phone:253-620-5015
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:1101 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2010
Practice Address - Country:US
Practice Address - Phone:509-324-1415
Practice Address - Fax:509-327-0163
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00003664101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)