Provider Demographics
NPI:1023600772
Name:JOHNSON, ANDREW A (BA BS MSW LICSW LADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BA BS MSW LICSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 GLENDON ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3811
Mailing Address - Country:US
Mailing Address - Phone:612-354-9027
Mailing Address - Fax:
Practice Address - Street 1:981 GLENDON ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-3811
Practice Address - Country:US
Practice Address - Phone:612-354-9027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304558101YA0400X
MN261441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty