Provider Demographics
NPI:1346841384
Name:JOHNSON, KAREN YVETTE (LCAS-A)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:YVETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SAINT CHRISTOPHER CIR SW APT 1
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4474
Mailing Address - Country:US
Mailing Address - Phone:984-363-0249
Mailing Address - Fax:
Practice Address - Street 1:2500 SAINT CHRISTOPHER CIR SW APT 1
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4474
Practice Address - Country:US
Practice Address - Phone:984-528-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)