Provider Demographics
NPI:1417016791
Name:JOHNSON, DEBRA MAINOR (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MAINOR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HAY ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5676
Mailing Address - Country:US
Mailing Address - Phone:910-797-7354
Mailing Address - Fax:
Practice Address - Street 1:100 HAY ST
Practice Address - Street 2:SUITE 701
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5676
Practice Address - Country:US
Practice Address - Phone:910-797-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0072171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical