Provider Demographics
NPI:1487822995
Name:JOHNSON, CAROL PETTY (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:PETTY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 WEST LOOP S
Mailing Address - Street 2:SUITE 515
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2421
Mailing Address - Country:US
Mailing Address - Phone:713-660-8882
Mailing Address - Fax:713-977-2319
Practice Address - Street 1:5959 WEST LOOP S
Practice Address - Street 2:SUITE 515
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2421
Practice Address - Country:US
Practice Address - Phone:713-660-8882
Practice Address - Fax:713-977-2319
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical