Provider Demographics
NPI:1457428450
Name:JOHNSON, DEBORAH R (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:R
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9933 W HAYES ST
Mailing Address - Street 2:NATIONAL CENTER FOR TELEHEALTH & TECHNOLOGY, JBLM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:210-563-4667
Mailing Address - Fax:
Practice Address - Street 1:9933 W HAYES ST
Practice Address - Street 2:NATIONAL CENTER FOR TELEHEALTH & TECHNOLOGY, JBLM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:210-563-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical