Provider Demographics
NPI:1669852414
Name:JOHNSON, KARON FALAQ (LCSW)
Entity Type:Individual
Prefix:
First Name:KARON
Middle Name:FALAQ
Last Name:JOHNSON
Suffix:
Gender:F
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:PO BOX 15811
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0811
Mailing Address - Country:US
Mailing Address - Phone:919-884-7831
Mailing Address - Fax:919-287-2786
Practice Address - Street 1:1200 BROAD ST STE 202
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3573
Practice Address - Country:US
Practice Address - Phone:919-884-7831
Practice Address - Fax:919-287-2786
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0102541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical