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Individual
MR. JACK EUGENE JOHNSON SR.
Active
Individual
MR. JACK EUGENE JOHNSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II/QMHP-C, CSWA
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00-11-45
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
17-CRM-078
OR
101YM0800X
Mental Health Counselor
24-QMHPC-001514
OR
1041C0700X
Clinical Social Worker
A11750
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500800849
—
OR
05
—
500801135
—
OR
Enumeration date
06/25/2008
Last updated
08/03/2026
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