Provider Demographics
NPI:1497298830
Name:JOHNSON, CALEY (LICSW)
Entity Type:Individual
Prefix:
First Name:CALEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 HARRIS AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7001
Mailing Address - Country:US
Mailing Address - Phone:360-323-4149
Mailing Address - Fax:
Practice Address - Street 1:1106 HARRIS AVE STE 211
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7001
Practice Address - Country:US
Practice Address - Phone:360-708-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60609278101YA0400X
WASC610879731041C0700X
WALW615069431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60827715OtherDOH
WACP60827715OtherWA STATE DEPARTMENT OF HEALTH
WA1497298830Medicaid
WACP60827715Medicaid