Provider Demographics
NPI:1508008038
Name:JOHNSON, SHARON P (LCAS, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCAS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PROVIDENCE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3226
Mailing Address - Country:US
Mailing Address - Phone:336-896-1323
Mailing Address - Fax:336-896-1327
Practice Address - Street 1:4401 PROVIDENCE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3226
Practice Address - Country:US
Practice Address - Phone:336-896-1323
Practice Address - Fax:336-896-1327
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16481101YP2500X, 101YA0400X
NCPO113071041C0700X
NCCO12183104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCO12183OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD
NCPO11307OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD
NC16481OtherNC SUBSTANCE ABUSE PROFESIONAL PRACTICE BOARD