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NPI Code Detail

MEDICARE: TIMOTHY JOHNSON LCSWA, LCAS, CSI

MEDICARE: TIMOTHY JOHNSON LCSWA, LCAS, CSI
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) CounselorLCAS-20437NC
21041C0700XClinical Social Worker0904015081VA
31041C0700XClinical Social WorkerP004704NC
41041C0700XClinical Social Worker15889SC

General Provider Information

NPI Number : 1689821720
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY JOHNSON LCSWA, LCAS, CSI
Provider Business Mailing Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-253-1924
Fax Number :
Provider Business Practice Location Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 980-202-1924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2008
Last Update Date : 05/12/2026

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