Provider Demographics
NPI:1164078465
Name:JOHNSON, CAITLIN M (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 W GRAVEL LN
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1711
Mailing Address - Country:US
Mailing Address - Phone:304-449-6498
Mailing Address - Fax:
Practice Address - Street 1:195 W GRAVEL LN
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1711
Practice Address - Country:US
Practice Address - Phone:304-449-6498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009455121041C0700X
VA09040176291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical