Provider Demographics
NPI:1245663137
Name:JOHNSON-HOSTLER, JUDITH A (LCAS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:JOHNSON-HOSTLER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057B BULLARD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6801
Mailing Address - Country:US
Mailing Address - Phone:919-521-5372
Mailing Address - Fax:919-341-2904
Practice Address - Street 1:1057B BULLARD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6801
Practice Address - Country:US
Practice Address - Phone:919-521-5372
Practice Address - Fax:919-341-2904
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)