Healthcare Provider Details

I. General information

NPI: 1912159187
Provider Name (Legal Business Name): ERIKA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 RUFFIN ST
DURHAM NC
27701-1214
US

IV. Provider business mailing address

1419 RUFFIN ST
DURHAM NC
27701-1214
US

V. Phone/Fax

Practice location:
  • Phone: 919-357-5709
  • Fax:
Mailing address:
  • Phone: 919-357-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: