Provider Demographics
NPI:1376838003
Name:JOHNSON, JANICE L (CCDC II)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 ABBEY ROAD
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-8841
Mailing Address - Fax:605-224-6852
Practice Address - Street 1:1714 ABBEY RD
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-7805
Practice Address - Country:US
Practice Address - Phone:605-224-8841
Practice Address - Fax:605-224-6852
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD08081371101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)