Provider Demographics
NPI:1760854954
Name:CHAVONN JOHNSON
Entity Type:Organization
Organization Name:CHAVONN JOHNSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHAVONN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:214-989-7492
Mailing Address - Street 1:1825 W WALNUT HILL LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3218
Mailing Address - Country:US
Mailing Address - Phone:214-989-7492
Mailing Address - Fax:
Practice Address - Street 1:1825 W WALNUT HILL LN
Practice Address - Street 2:SUITE 120
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3218
Practice Address - Country:US
Practice Address - Phone:214-989-7492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management