Healthcare Provider Details

I. General information

NPI: 1952493058
Provider Name (Legal Business Name): CHUCK WILLIAM JOHNSON LCPC, NCC, ACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 HIGHWAY 94 N
CAMP POINT IL
62320-2516
US

IV. Provider business mailing address

2170 HIGHWAY 94 N
CAMP POINT IL
62320-2516
US

V. Phone/Fax

Practice location:
  • Phone: 217-696-2751
  • Fax: 217-696-2751
Mailing address:
  • Phone: 217-696-2751
  • Fax: 217-696-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: