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General NPI Number Information
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NPI Number | 1578106845
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Entity Type | Individual
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Provider Name | MARY MARGARET JOHNSON LCSWA
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Gender | Female
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 6614 SHALLOWFORD RD. SUITE 250
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City | LEWISVILLE
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State | NC
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Zip | 27023
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Country | US
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Telephone | 336-945-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 2843 HERMITAGE DRIVE
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City | WINSTON-SALEM
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State | NC
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Zip | 27103
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Country | US
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Telephone | 336-972-7072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P013190
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License Number State | NC
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