Andra D. Johnson, LISW, LCSW, LCAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005636A (LCSW) Issued in IN

Practice address

4656 W Jefferson Blvd
Suite 285
Fort Wayne, IN 46804-6857

Phone

(260) 422-9372

Fax

(260) 672-0859

NPI assigned

Feb 1, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Mrs. Andra D Rivers-Jones Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Andra D. Johnson

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1336468271

  Addiction (Substance Use Disorder)

  NPD (past) Authorized official
• Able Counseling & Associates, Inc.

  • Professional Counselor
  • Cleveland, OH
  • NPI 1225258742

  Clinical

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1093787426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11014 CONSTANTIA CV",
            "city": "ROANOKE",
            "state": "IN",
            "postal_code": "467838910",
            "telephone_number": "216-798-1997",
            "fax_number": "260-672-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "SUITE 285",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857",
            "telephone_number": "260-422-9372",
            "fax_number": "260-672-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANDRA",
        "middle_name": "D.",
        "name_prefix": "Mrs.",
        "credential": "LISW, LCSW, LCAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "991842 (LICDC)",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I - 0009358 (LISW)",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2979-123 (LCSW)",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005636A (LCSW)",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87000438A (LCAC)",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39628200 -31/078",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDRA",
            "last_name": "RIVERS-JONES",
            "middle_name": "D",
            "prefix": "MRS.",
            "credential": "M.S.S.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lacey S Johns
• Johnson Memorial Hospital
• Abigail Johnson
• Adrienne A Johnson, TLMHCA, ATR-P
• Alison Johnson, MS, RDN, LDN
• Brandi Sue Johnson, PHARMD
• Brandon Lee Johnson, FNP-C
• Brian Ernest Johnson, M.D.
• Brian L Johnson, QMA
• Candace Johnson

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.