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Individual
MRS. KELLY COLLEEN JOHNSON
Active
Individual
MRS. KELLY COLLEEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149.019599
IL
1041C0700X
Clinical Social Worker
Primary
C012146
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427573476
NPI TYPE I
—
01
—
149019599
STATE LICENSE
IL
01
—
C012146
STATE LICENSE
NC
Enumeration date
08/11/2017
Last updated
08/14/2019
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