Provider Demographics
NPI:1306825138
Name:JOHNSON, CHERYL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 W MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4304
Mailing Address - Country:US
Mailing Address - Phone:919-624-2621
Mailing Address - Fax:
Practice Address - Street 1:278 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4304
Practice Address - Country:US
Practice Address - Phone:919-624-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC086793OtherVALUE OPTIONS
NC2876OtherNC PSYCHOLOGY BD LICENSE
NC46389OtherBLUECROSSBLUESHIELD
NC2876OtherNC PSYCHOLOGY BD LICENSE