Provider Demographics
NPI:1477047561
Name:JOHNSON, WALTER SIR ANTHONY III (MSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:SIR ANTHONY
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MSW
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Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:130 CARBONTON RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4009
Practice Address - Country:US
Practice Address - Phone:919-774-6521
Practice Address - Fax:919-776-6179
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCP0127281041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical