MEDICARE: HEAVEN JOHNSON

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1720931066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEAVEN JOHNSON

Provider Business Mailing Address
First Line	:	20 FIVE POINTS DR
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-8501
Country	:	US
Telephone Number	:	910-234-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 S JK POWELL BLVD STE C
Second Line	:
City	:	WHITEVILLE
State	:	NC
Zip	:	28472-9145
Country	:	US
Telephone Number	:	910-642-6211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ HEAVEN JOHNSON ” Practice Location

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