| Kelly C. Johnson Lcsw, P.l.l.c. | |
|
2530 Meridian Parkway Suite 300, Pbn: 3071 Durham NC 27713-5273 | |
| (919) 437-6627 | |
| (919) 258-2490 |
| Full Name | Kelly C. Johnson Lcsw, P.l.l.c. |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2530 Meridian Parkway, Durham, North Carolina |
| Authorized Official Name and Position | Kelly C Johnson (MEMBER) |
| Authorized Official Contact | 9194376627 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kelly C. Johnson Lcsw, P.l.l.c. 2530 Meridian Parkway Suite 300, Pbn: 3071 Durham NC 27713-5273 Ph: (919) 437-6627 | Kelly C. Johnson Lcsw, P.l.l.c. 2530 Meridian Parkway Suite 300, Pbn: 3071 Durham NC 27713-5273 Ph: (919) 437-6627 |
| NPI Number | 1205482460 |
|---|---|
| Provider Enumeration Date | 08/14/2019 |
| Last Update Date | 08/14/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205482460 | NPI | - | NPPES |
| C012146 | Other | NC | STATE LICENSE |
| 149019599 | Other | IL | STATE LICENSE |
| 1427573476 | Other | NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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Anfo Child And Adult Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3519 Fayetteville St, Durham, NC 27707 Phone: 919-806-2833 | |
Branching Out Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 412 W Markham Ave, Durham, NC 27701 Phone: 919-884-1542 | |
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