Provider Demographics
NPI:1861234049
Name:JOHNSON, CRAIG (LMHC, CASAC-G)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC, CASAC-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4007
Mailing Address - Country:US
Mailing Address - Phone:585-314-9999
Mailing Address - Fax:
Practice Address - Street 1:215 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4007
Practice Address - Country:US
Practice Address - Phone:585-314-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty