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General NPI Number Information
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NPI Number | 1730619859
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Entity Type | Individual
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Provider Name | RONALD ROBERT JOHNSON LCAS (REGISTERED)
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Gender | Male
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 3826 BLAND RD
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City | RALEIGH
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State | NC
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Zip | 27609
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Country | US
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Telephone | 919-872-1441
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Fax | 919-872-1455
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Provider Business Mailing Address
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Address Line | 3111 LONG MEADOW CT APT 203
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City | RALEIGH
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State | NC
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Zip | 27613-3216
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Country | US
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Telephone | 919-436-0413
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23707
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13636
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License Number State | NC
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