Provider Demographics
NPI:1396031787
Name:JOHNSON, GERI J (MDIV, NCAC I)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MDIV, NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3250
Mailing Address - Country:US
Mailing Address - Phone:828-456-8604
Mailing Address - Fax:828-456-9018
Practice Address - Street 1:131 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3250
Practice Address - Country:US
Practice Address - Phone:828-456-8604
Practice Address - Fax:828-456-9018
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
NC9518101YP2500X
NC1851101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)