Provider Demographics
NPI:1437135704
Name:JOHNSON, NANCY LOUISE (LCSW, CAC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, CAC, CSAC
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:LOUISE
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CAC, CSAC
Mailing Address - Street 1:1 VA CTR
Mailing Address - Street 2:BUILDING 206
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6719
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-623-5791
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:BUILDING 206
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6719
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-623-5791
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA89215101YA0400X
VA0710000655101YA0400X
VA09040034201041C0700X
MELC140261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)