Healthcare Provider Details

I. General information

NPI: 1801415468
Provider Name (Legal Business Name): PAMELA L JOHNSON LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 LANDING FALLS LN
RALEIGH NC
27616-8385
US

IV. Provider business mailing address

3221 LANDING FALLS LN
RALEIGH NC
27616-8385
US

V. Phone/Fax

Practice location:
  • Phone: 919-295-2078
  • Fax: 919-295-2078
Mailing address:
  • Phone: 919-295-2078
  • Fax: 919-295-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-23192
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: