Organization
ANDRA D. JOHNSON
Active
Other names
Four Rivers & Associates LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDRA D JOHNSON LISW, LCSW, LCAC (OWNER)
(216) 798-1997
Entity
Organization
Contact information
Practice address
4656 W JEFFERSON BLVD, SUITE 285, FORT WAYNE, IN 46804-6857
(260) 422-9372
(260) 672-0859
Mailing address
11014 CONSTANTIA CV, ROANOKE, IN 46783-8910
(216) 798-1997
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87000438A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
991842
OH
1041C0700X
Clinical Social Worker
2972-123
WI
1041C0700X
Clinical Social Worker
Primary
34005636A
IN
1041C0700X
Clinical Social Worker
I-0009358
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39628200 (-31/078)
—
WI
Enumeration date
05/18/2010
Last updated
10/17/2011
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