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General NPI Number Information
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NPI Number | 1740095066
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Entity Type | Individual
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Provider Name | SHALONDA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 50 TUN TAVERN DR
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City | CAMERON
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State | NC
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Zip | 28326-5523
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Country | US
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Telephone | 910-354-8731
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Fax |
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Provider Business Mailing Address
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Address Line | 6321 RAEFORD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2810
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Country | US
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Telephone | 910-485-6336
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Fax | 888-972-8390
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P021490
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License Number State | NC
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