Healthcare Provider Details

I. General information

NPI: 1215702576
Provider Name (Legal Business Name): CHOICEPOINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23-00 ROUTE 208 STE 2-9
FAIR LAWN NJ
07410-1558
US

IV. Provider business mailing address

4009 MASONBORO LOOP RD
WILMINGTON NC
28409-3640
US

V. Phone/Fax

Practice location:
  • Phone: 908-948-8802
  • Fax:
Mailing address:
  • Phone: 844-445-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN X JOHNSON
Title or Position: CEO
Credential:
Phone: 704-450-2117