Provider Demographics
NPI:1801517925
Name:JOHNSON, JUVONNE MONIQUE (PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:JUVONNE
Middle Name:MONIQUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-5083
Mailing Address - Country:US
Mailing Address - Phone:336-602-7399
Mailing Address - Fax:
Practice Address - Street 1:1745 BURTON ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5083
Practice Address - Country:US
Practice Address - Phone:336-602-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-034-402251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health