Provider Demographics
NPI:1356868145
Name:JOHNSON, SHANICE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANICE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W CABARRUS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1953
Mailing Address - Country:US
Mailing Address - Phone:919-833-3312
Mailing Address - Fax:919-833-3512
Practice Address - Street 1:600 W CABARRUS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1953
Practice Address - Country:US
Practice Address - Phone:919-833-3312
Practice Address - Fax:919-833-3512
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0127251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical