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MRS. ANDRA D. JOHNSON LISW, LCSW, LCAC

Addiction Substance Use Disorder

Fort Wayne, Indiana

Provider NPI: 1093787426

Provider Information:
MRS. ANDRA D. JOHNSON LISW, LCSW, LCAC
Gender: F
Sole Proprietor


Practice Location:
4656 W JEFFERSON BLVD SUITE 285 FORT WAYNE, IN 46804 US
Tel: 260-422-9372  Fax: 260-672-0859

Business Mailing Address:
11014 CONSTANTIA CV  ROANOKE, IN 46783 US
Tel: 216-798-1997  Fax: 260-672-0859

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
OH991842 (LICDC)
N101YA0400XBehavioral Health & Social Service Providers
Counselor
IN87000438A (LCAC)
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
IN34005636A (LCSW)
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
WI2979-123 (LCSW)
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
OHI - 0009358 (LISW)

Other Provider Identifiers:

IssuerNumberStateType
39628200 -31/078WI05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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