Provider Demographics
NPI:1902192834
Name:JOHNSON BEHAVIORAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:JOHNSON BEHAVIORAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-889-3967
Mailing Address - Street 1:4611 WESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1815
Mailing Address - Country:US
Mailing Address - Phone:919-851-4343
Mailing Address - Fax:919-851-4345
Practice Address - Street 1:4611 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1815
Practice Address - Country:US
Practice Address - Phone:919-851-4343
Practice Address - Fax:919-851-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)