Provider Demographics
NPI:1649544735
Name:JOHNSON, RODNEY (CADC, LCPC)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CADC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 HOMERIA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1839
Mailing Address - Country:US
Mailing Address - Phone:702-956-2009
Mailing Address - Fax:
Practice Address - Street 1:2780 S JONES BLVD STE 115D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5625
Practice Address - Country:US
Practice Address - Phone:702-935-0025
Practice Address - Fax:702-935-0008
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00714-C101YA0400X
NVCI636101YP2500X
NVCP5226-R101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)