Provider Demographics
NPI:1669516209
Name:JOHNSON, PATRICIA ANN (LCSW, CSAC, MAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, CSAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-120 FARRINGTON HWY
Mailing Address - Street 2:A-107
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3000
Mailing Address - Country:US
Mailing Address - Phone:808-292-8685
Mailing Address - Fax:808-696-5079
Practice Address - Street 1:86-120 FARRINGTON HWY
Practice Address - Street 2:A-107
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3000
Practice Address - Country:US
Practice Address - Phone:808-292-8685
Practice Address - Fax:808-696-5079
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI31851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical