Provider Demographics
NPI:1609273226
Name:JOHNSON, BETTY (CSAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 SHOTWELL RD
Mailing Address - Street 2:104 A
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-359-0669
Mailing Address - Fax:919-359-2171
Practice Address - Street 1:935 SHOTWELL RD
Practice Address - Street 2:104 A
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5597
Practice Address - Country:US
Practice Address - Phone:919-359-0669
Practice Address - Fax:919-359-2171
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16453101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)