Provider Demographics
NPI:1972977189
Name:JOHNSON, CHAVONN M (LCSW, LCDC-I, CCM)
Entity Type:Individual
Prefix:
First Name:CHAVONN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LCDC-I, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 CLAYTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4101
Mailing Address - Country:US
Mailing Address - Phone:817-760-0481
Mailing Address - Fax:
Practice Address - Street 1:733 HIGHWAY 287 N STE 311
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2765
Practice Address - Country:US
Practice Address - Phone:817-914-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61334171M00000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical