Johnson, Andra D.
Johnson, Andra D. is an sole proprietor health care provider with primary practice located at 4656 W Jefferson Blvd Suite 285, Fort Wayne IN 46804-6857. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Johnson, Andra D. can be contacted via phone (260) 422-9372.Contact Information
Primary practice address
4656 W Jefferson Blvd Suite 285
Fort Wayne IN 46804-6857
Phone: (260) 422-9372
Fax: (260) 672-0859
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 991842 (LICDC) | Ohio |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | I - 0009358 (LISW) | Ohio |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 2979-123 (LCSW) | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 34005636A (LCSW) | Indiana |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 87000438A (LCAC) | Indiana |
Profile Details
| NPI number | 1093787426 |
|---|---|
| LBN Legal business name | Johnson, Andra D. |
| Credentials | LISW, LCSW, LCAC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 1st, 2006 |
| Last updated | Oct 17th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1093787426 | NPPES |
| Wisconsin | MEDICAID | 39628200 -31/078 |
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