MEDICARE: PAMELA L JOHNSON LCASA

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-23192	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	398916	OTHER	NC	NC DRIVER LICENSE

General Provider Information

NPI Number	:	1801415468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA L JOHNSON LCASA

Provider Business Mailing Address
First Line	:	3221 LANDING FALLS LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8385
Country	:	US
Telephone Number	:	919-295-2078
Fax Number	:	919-295-2078

Provider Business Practice Location Address
First Line	:	3221 LANDING FALLS LN
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-8385
Country	:	US
Telephone Number	:	919-295-2078
Fax Number	:	919-295-2078

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

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	03/31/2026

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