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NPI Code Detail

MEDICARE: MS. SHANICE M JOHNSON LCSW

MEDICARE: MS. SHANICE M JOHNSON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC012725NC

General Provider Information

NPI Number : 1356868145
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANICE M JOHNSON LCSW
Provider Business Mailing Address
First Line : 110 N CORCORAN ST
Second Line :
City : DURHAM
State : NC
Zip : 27701-5015
Country : US
Telephone Number : 919-961-3867
Fax Number :
Provider Business Practice Location Address
First Line : 110 N CORCORAN ST
Second Line :
City : DURHAM
State : NC
Zip : 27701-5015
Country : US
Telephone Number : 919-961-3867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2017
Last Update Date : 06/02/2025

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