Provider Demographics
NPI:1982031043
Name:JOHNSON, DARNELL (LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:DARNELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 WATERS EDGE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2462
Mailing Address - Country:US
Mailing Address - Phone:919-805-6046
Mailing Address - Fax:919-573-0847
Practice Address - Street 1:4909 WATERS EDGE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2462
Practice Address - Country:US
Practice Address - Phone:919-805-6046
Practice Address - Fax:919-573-0847
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9050101YP2500X
NC2627101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)