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General NPI Number Information
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NPI Number | 1942924436
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Entity Type | Individual
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Provider Name | QUINCY B JOHNSON CPC , CRM, CGRM
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Gender | Male
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 10209 SE DIVISION ST BLDG C
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City | PORTLAND
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State | OR
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Zip | 97266-1372
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Country | US
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Telephone | 503-228-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 542 NE ANDERSON ST
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City | VANCOUVER
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State | WA
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Zip | 98665-8333
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Country | US
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Telephone | 360-839-6813
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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 |
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License Number State | WA
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