MEDICARE: DR. OLIVER JAMES JOHNSON PH.D., LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-2082	NC
2	1041C0700X	Clinical Social Worker	C005934	NC

General Provider Information

NPI Number	:	1073813408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER JAMES JOHNSON PH.D., LCSW

Provider Business Mailing Address
First Line	:	4911 COOPER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-0823
Country	:	US
Telephone Number	:	910-578-5169
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 HAY ST STE 201
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5352
Country	:	US
Telephone Number	:	910-483-5986
Fax Number	:	910-483-2876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	03/09/2023

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