Provider Demographics
NPI:1437233913
Name:JOHNSON, CAROL A (MA, EDS)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PAGODA CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4830
Mailing Address - Country:US
Mailing Address - Phone:609-333-1319
Mailing Address - Fax:609-924-7436
Practice Address - Street 1:22 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6813
Practice Address - Country:US
Practice Address - Phone:609-924-0060
Practice Address - Fax:609-924-7436
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00019900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional