Provider Demographics
NPI:1730619859
Name:JOHNSON, RONALD ROBERT (LCAS (REGISTERED))
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ROBERT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCAS (REGISTERED)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 LONG MEADOW CT APT 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3216
Mailing Address - Country:US
Mailing Address - Phone:919-436-0413
Mailing Address - Fax:
Practice Address - Street 1:3826 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-872-1441
Practice Address - Fax:919-872-1455
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23707101YA0400X
NC13636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)