Provider Demographics
NPI:1639731078
Name:CONTRERAS, JOHANNA ALEXANDRA (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ALEXANDRA
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4137
Mailing Address - Country:US
Mailing Address - Phone:919-613-5949
Mailing Address - Fax:919-613-5970
Practice Address - Street 1:823 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4137
Practice Address - Country:US
Practice Address - Phone:919-613-5949
Practice Address - Fax:919-613-5970
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0136831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical