Individual
MRS. MELISSA M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
(815) 756-2944
Mailing address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
(815) 756-2944
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
104100000X
Social Worker
Primary
149.021116
IL
1041C0700X
Clinical Social Worker
149.021116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362771343001
—
IL
Enumeration date
08/06/2015
Last updated
10/21/2020
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