Provider Demographics
NPI:1376668095
Name:JOHNSON, BERNADETTE LEA (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:LEA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:LEA
Other - Last Name:SCHRAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1650 GREENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6456
Mailing Address - Country:US
Mailing Address - Phone:910-798-3500
Mailing Address - Fax:910-798-7834
Practice Address - Street 1:1650 GREENFIELD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6456
Practice Address - Country:US
Practice Address - Phone:910-798-3500
Practice Address - Fax:910-798-7834
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0048691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13990OtherBCBS
NC6003470Medicaid