Provider Demographics
NPI:1639713324
Name:JOHNSON, ERIC ANDREW (PLADC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 KIPLING CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-2752
Mailing Address - Country:US
Mailing Address - Phone:402-309-6981
Mailing Address - Fax:
Practice Address - Street 1:301 S 70TH ST # 313
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2469
Practice Address - Country:US
Practice Address - Phone:402-309-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP-1733OtherSTATE PROFESSIONAL LICENSE-PLADC