Provider Demographics
NPI:1760943740
Name:JOHNSON, DEBORAH (LAC, NCCAOM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC, NCCAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 HONEY LOCUST CIR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2680
Mailing Address - Country:US
Mailing Address - Phone:786-223-5100
Mailing Address - Fax:
Practice Address - Street 1:55 HOSPITAL CENTER CMNS
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2837
Practice Address - Country:US
Practice Address - Phone:843-277-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC306171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist