Provider Demographics
NPI:1487026845
Name:JOHNSON, EILEEN (DN, LMT,CADC)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DN, LMT,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 SOUTHWEST HWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:SUITE 230
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:847-493-3659
Practice Address - Fax:847-493-3666
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL362709982101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)