Healthcare Provider Details

I. General information

NPI: 1457428450
Provider Name (Legal Business Name): DEBORAH R. JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH R. MCCOY

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9933 W HAYES ST NATIONAL CENTER FOR TELEHEALTH & TECHNOLOGY, JBLM
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9933 W HAYES ST NATIONAL CENTER FOR TELEHEALTH & TECHNOLOGY, JBLM
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 210-563-4667
  • Fax:
Mailing address:
  • Phone: 210-563-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: