Provider Demographics
NPI:1538415336
Name:JOHANSEN, CHERI LYNN (LMSW, MAC, QAP)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:LMSW, MAC, QAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 130
Mailing Address - Street 2:6000 KANAKANAK ROAD
Mailing Address - City:BILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576
Mailing Address - Country:US
Mailing Address - Phone:907-842-5266
Mailing Address - Fax:907-842-5915
Practice Address - Street 1:6000 KANAKANAK ROAD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-5266
Practice Address - Fax:907-842-5174
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK103526104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker