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Individual

DEANGILA JENALL JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CADC-R

Contact information

Practice address
8570 NC HIGHWAY 211 E, LUMBERTON, NC 28358-7763
(910) 751-3036
(910) 739-4681
Mailing address
8570 NORTH CAROLINA 211 E, LUMBERTON, NC 28358-1205
(910) 751-3036

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CADC-30672
NC
235Z00000X
Speech-Language Pathologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7200535
NC
Enumeration date
10/29/2012
Last updated
05/02/2025
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