Provider Demographics
NPI:1902280514
Name:JOHNSON, DONEICIA RACHELLE (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:DONEICIA
Middle Name:RACHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 DAYBROOK CIR
Mailing Address - Street 2:APT 308
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2868
Mailing Address - Country:US
Mailing Address - Phone:719-231-2545
Mailing Address - Fax:
Practice Address - Street 1:6420 DAYBROOK CIR
Practice Address - Street 2:APT 308
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2868
Practice Address - Country:US
Practice Address - Phone:719-231-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0096831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP009683OtherLICENSE CLINICAL SOCIAL WORKER ASSOCIATE NUMBER