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NPI Code Detail

MEDICARE: SAMANTHA JOHNSON

MEDICARE: SAMANTHA JOHNSON
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCAPRE.196016OH
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1548114044
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JOHNSON
Provider Business Mailing Address
First Line : 680 PARK AVE W
Second Line :
City : MANSFIELD
State : OH
Zip : 44906-3706
Country : US
Telephone Number : 419-528-5993
Fax Number : 567-560-5483
Provider Business Practice Location Address
First Line : 680 PARK AVE W
Second Line :
City : MANSFIELD
State : OH
Zip : 44906-3706
Country : US
Telephone Number : 419-528-5993
Fax Number : 567-560-5483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2026
Last Update Date : 05/08/2026

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