Provider Demographics
NPI:1811571193
Name:JOHNSON, CATRINNA LASHAY
Entity Type:Individual
Prefix:MRS
First Name:CATRINNA
Middle Name:LASHAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3218
Mailing Address - Country:US
Mailing Address - Phone:434-229-2732
Mailing Address - Fax:
Practice Address - Street 1:2245 CAROLINA BEACH RD STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7651
Practice Address - Country:US
Practice Address - Phone:434-229-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist