Provider Demographics
NPI:1659559649
Name:JOHNSON, JAMES R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINGS DAUGHTERS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4248
Mailing Address - Country:US
Mailing Address - Phone:502-227-3222
Mailing Address - Fax:502-223-7491
Practice Address - Street 1:130 KINGS DAUGHTERS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4187
Practice Address - Country:US
Practice Address - Phone:502-227-3222
Practice Address - Fax:502-223-7491
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0732104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker