Provider Demographics
NPI:1669406120
Name:JOHNSON, REGINA E (LMSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 ACADEMY RD NE APT 1422
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7334
Mailing Address - Country:US
Mailing Address - Phone:505-318-1475
Mailing Address - Fax:
Practice Address - Street 1:10700 ACADEMY RD NE APT 1422
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7334
Practice Address - Country:US
Practice Address - Phone:505-318-1475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-063661041C0700X
NM3606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)