Provider Demographics
NPI:1720210990
Name:JOHNSON, CHARLOTTE NADEANE (MS)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:NADEANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3642
Mailing Address - Country:US
Mailing Address - Phone:425-349-3191
Mailing Address - Fax:425-259-3073
Practice Address - Street 1:2802 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3642
Practice Address - Country:US
Practice Address - Phone:425-259-3191
Practice Address - Fax:425-259-3073
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC600044733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health