Provider Demographics
NPI:1952493058
Name:JOHNSON, CHUCK WILLIAM (LCPC, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:CHUCK
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 HIGHWAY 94 N
Mailing Address - Street 2:
Mailing Address - City:CAMP POINT
Mailing Address - State:IL
Mailing Address - Zip Code:62320-2516
Mailing Address - Country:US
Mailing Address - Phone:217-696-2751
Mailing Address - Fax:217-696-2751
Practice Address - Street 1:2170 HIGHWAY 94 N
Practice Address - Street 2:
Practice Address - City:CAMP POINT
Practice Address - State:IL
Practice Address - Zip Code:62320-2516
Practice Address - Country:US
Practice Address - Phone:217-696-2751
Practice Address - Fax:217-696-2751
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional