Provider Demographics
NPI:1336858638
Name:JOHNSON, PAUL DWIGHT (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DWIGHT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 DURHAM CHAPEL HILL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2877
Mailing Address - Country:US
Mailing Address - Phone:919-402-8738
Mailing Address - Fax:
Practice Address - Street 1:2634 DURHAM CHAPEL HILL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2877
Practice Address - Country:US
Practice Address - Phone:919-402-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0180631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical