Provider Demographics
NPI:1316197031
Name:JOHNSON, GEMINI JEWEL (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GEMINI
Middle Name:JEWEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MEDICAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3374
Mailing Address - Country:US
Mailing Address - Phone:252-335-2018
Mailing Address - Fax:833-287-6271
Practice Address - Street 1:1129 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8507
Practice Address - Country:US
Practice Address - Phone:252-335-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0071281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical